Latest / Lab to Lives / Pharma Wants A Cupcake But Gets Ingredients w/ Dr. Isabelle Widmer

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Pharma Wants A Cupcake But Gets Ingredients w/ Dr. Isabelle Widmer · Lab to Lives

• 0:00
  SPEAKER_02: Welcome to another episode of Lab Twice.
• 0:02
  SPEAKER_02: Today Alex and I are hosting, and our guest is Isabel.
• 0:06
  SPEAKER_02: Isabel and I met on LinkedIn and we started talking about something completely different and somehow find our way to the recording studio together today.
• 0:15
  SPEAKER_02: So Isabel, on this show, we usually let our guests introduce themselves in terms of where they are at in pharma.
• 0:23
  SPEAKER_02: In this show, we preach that there are five major value streams in a photo company.
• 0:28
  SPEAKER_02: There is the innovation stream, there is the manufacturing stream, there is the compliance stream, the commercial stream, and the corporate stream.
• 0:36
  SPEAKER_02: So if you were to place yourself somewhere among these five value streams, which one would you pick?
• 0:42
  SPEAKER_02: I love the streams.
• 0:43
  SPEAKER_01: I think I challenge them, but you're welcome to.
• 0:46
  SPEAKER_01: Well I work to think of it.
• 0:48
  SPEAKER_01: You've got innovation, compliance, what was it, manufacturing, commercial, or what was the last one?
• 0:52
  SPEAKER_01: Corporate.
• 0:53
  SPEAKER_01: I forgot the corporate.
• 0:55
  SPEAKER_01: So I think that's pretty much pharma, right?
• 0:57
  SPEAKER_01: It's silos and you can't have silos.
• 0:59
  SPEAKER_01: I help people get things done across the silos.
• 1:02
  SPEAKER_01: So if they have problems that they're stuck in, talk to any team and they'll say, the compliance people stop me.
• 1:09
  SPEAKER_01: Or the corporate people don't understand my science.
• 1:12
  SPEAKER_01: It's one of those practical things in life, you go, this bit's stopping me, so I can't do it.
• 1:16
  SPEAKER_01: And you're like, haven't got a budget.
• 1:17
  SPEAKER_01: So what I typically do, my favorite, favorite, favorite, favorite topics are teams who call me and say, we have a huge project that we've worked on for a year and a half and it's about to hit a wall.
• 1:27
  SPEAKER_01: Can you help us fix it?
• 1:28
  SPEAKER_01: And then I typically go in and I look at it.
• 1:31
  SPEAKER_01: So I work as a consultant, but because I've been consulting for 13 years now, and every project I do, the technical aspect is never a problem.
• 1:40
  SPEAKER_01: So the technical aspect, farmer knows technical aspects, they know the compliance, they know the regulations.
• 1:45
  SPEAKER_01: The bit that gets people stuck is how do different countries work, how do different cultures work?
• 1:50
  SPEAKER_01: Sam doesn't like Susan, who got a promotion, and Sam thinks you should have got a promotion, right?
• 1:54
  SPEAKER_01: It's a human aspect.
• 1:55
  SPEAKER_01: So while I help people on the transformations and forcing silos, what I do, which I do with a technical background.
• 2:01
  SPEAKER_01: So my background is I'm a physician, I've got a research background, I worked in pharma for a lot of years.
• 2:05
  SPEAKER_01: I wasn't a great employee because I kept going, here's another gap we need to fix.
• 2:10
  SPEAKER_01: People go, off you go, you go fix that gap.
• 2:12
  SPEAKER_01: And at some point you're accumulating projects, right?
• 2:14
  SPEAKER_01: I've got a really long Excel list of projects that I'm fixing because I keep seeing things that we need to fix.
• 2:18
  SPEAKER_01: And so I thought I could do that externally.
• 2:20
  SPEAKER_01: And I added in the systemic coaching approach because when I work with teams that are stuck, I often make them draw first.
• 2:27
  SPEAKER_01: So I make them paint an image of what's happening because that takes them out of the org chart and the thinking and it makes them grounded.
• 2:32
  SPEAKER_01: In summary, I work across silos and help people fix things that internally are hard to fix.
• 2:37
  SPEAKER_03: I mean, majorly this immediately gets to the root of some of the challenges, right?
• 2:40
  SPEAKER_03: Because someone who sits in a company and identify gaps that needs to be filled and then goes and does it might normally be called quite a good employee.
• 2:50
  SPEAKER_03: So uh what do you think is going on there?
• 2:52
  SPEAKER_03: Why in pharma does that equal being a bad employee, perhaps?
• 2:56
  SPEAKER_01: Well, it depends on who's looking at it, right?
• 2:57
  SPEAKER_01: So I think for me, I was hired when I started working in pharma initially, I was hired to analyze market access.
• 3:03
  SPEAKER_01: I interviewed our customers.
• 3:04
  SPEAKER_01: You could give them presents, right?
• 3:05
  SPEAKER_01: So back then, this was 2006.
• 3:07
  SPEAKER_01: I said, and this is very manipulative and biased, but I am a physician and I'm allowed.
• 3:11
  SPEAKER_01: So this was in the Swiss market, so I assumed the important ones are male, and I assumed that most of them have a bad conscience because they work all the time.
• 3:18
  SPEAKER_01: This might be wrong, but there we go.
• 3:19
  SPEAKER_01: And so I said, We'll send a bunch of flowers to anybody of your choice.
• 3:22
  SPEAKER_01: Give us your name when you fill in the survey.
• 3:24
  SPEAKER_01: Which was useful because that way I knew who was answering.
• 3:26
  SPEAKER_01: And I also asked the tuck company, the people in the company, what they think the doctors experience, and there was not a match.
• 3:32
  SPEAKER_01: I said, okay, you think you know what your customers want, but actually your customers want something different, and you don't actually have that match.
• 3:37
  SPEAKER_01: And that was sort of where I started.
• 3:38
  SPEAKER_01: So it was already a research consultative approach.
• 3:41
  SPEAKER_01: And uh, the bad employee thing is I think it's maybe bad is wrong, maybe it's slightly uncomfortable.
• 3:46
  SPEAKER_01: If you're constantly looking for ways to make things better, and let's say I was young and dynamic then, so you don't have the political lingo, either you just go, oh, there's a gap, let's fix it.
• 3:54
  SPEAKER_01: And there's the awareness of how do I communicate that to people and how do I not step on toes?
• 3:59
  SPEAKER_01: I think that that is the bad piece, but also you challenge people, right?
• 4:02
  SPEAKER_01: You're saying, isn't there a better way?
• 4:05
  SPEAKER_01: Um maybe a better way means you have to work differently, maybe you have to talk to different people, maybe you have to, I don't know, just readapt in some ways.
• 4:13
  SPEAKER_01: And that's not that people don't want to do it, but they don't like somebody else who doesn't know anything about their area coming and going, I think I see a gap here, right?
• 4:20
  SPEAKER_01: No, I mean nobody likes that.
• 4:21
  SPEAKER_01: I wouldn't like that either, so that's totally understandable.
• 4:23
  SPEAKER_01: I once went to the head of the company and I said, Look, the job I'm doing is never gonna work.
• 4:27
  SPEAKER_01: I'm implementing an IT system, you hired me to do this.
• 4:30
  SPEAKER_01: Nobody wants this system.
• 4:31
  SPEAKER_01: Your senior team is totally blocking it.
• 4:34
  SPEAKER_01: I think we should just kill the project.
• 4:35
  SPEAKER_01: And he said, Are you talking yourself out of a job?
• 4:37
  SPEAKER_01: I'm like, Well, not really.
• 4:39
  SPEAKER_01: I'm just saying, and so this is the interpreneurial part, right?
• 4:41
  SPEAKER_01: You sort of go, you're paying money to build a system that's gonna die.
• 4:45
  SPEAKER_01: You're paying my salary to do something that's gonna die.
• 4:48
  SPEAKER_01: That's like a net cost sunk for no benefit.
• 4:50
  SPEAKER_01: And he said, I've never had anybody try and talk themselves out a job before.
• 4:53
  SPEAKER_01: I'm like, well, you think I'm any good, you'll probably find me something else, and you think I'm rubbish, it's probably good I know early on.
• 4:59
  SPEAKER_01: So I think it's just that these kinds of things are easier to do from outside because people sign up for them, right?
• 5:05
  SPEAKER_01: They're like, okay, I know that you're going to challenge me, but I know that that will probably, I mean, maybe not, but it might bring us further, and we're currently stuck, so we're open to that.
• 5:14
  SPEAKER_02: Yeah.
• 5:14
  SPEAKER_02: It's an eternal dilemma for my part, because I have experienced the exact same thing in life sciences that the slowness in the process is in part because, for example, that there are two departments that don't get along in a company.
• 5:28
  SPEAKER_02: The easy ways to fix that process are just not happening because people do not want to sit together in a room and figure out how to work together.
• 5:35
  SPEAKER_02: It's a lot of simple things like that.
• 5:36
  SPEAKER_02: Like I keep arguing, well, I totally agree to the consultant perspective, yeah, but I stay in pharma because I think some things require that someone sits and holds the space for the fixing.
• 5:48
  SPEAKER_02: And that is not always successful.
• 5:50
  SPEAKER_02: There is this dilemma between the two.
• 5:53
  SPEAKER_02: And I'm curious, both maybe Isabel and Alex, how is a fixing pharma working from an external perspective?
• 5:59
  SPEAKER_02: Alex, you want to go first?
• 6:01
  SPEAKER_03: I would let you go first, but no, I can go first.
• 6:03
  SPEAKER_03: But well, it's slow.
• 6:05
  SPEAKER_03: And I think we all know that.
• 6:06
  SPEAKER_03: I think that's why we're doing this podcast.
• 6:08
  SPEAKER_03: I always hesitate a little bit to criticize.
• 6:11
  SPEAKER_03: It sounds like you're giving very personal criticism of these people are slow or these people are doing it wrong.
• 6:17
  SPEAKER_03: And I I think that's a tricky situation to get into.
• 6:19
  SPEAKER_03: And one of the things that I liked about coming across you, Isabel, is that actually I think a lot of this is about humans operating in a system.
• 6:26
  SPEAKER_03: And when the system isn't set up in a way that embodies or enables people to succeed, then we get problems.
• 6:32
  SPEAKER_03: And I think right now we've got a well entrenched system that necessarily working, and that is always slow and difficult to change.
• 6:41
  SPEAKER_03: And I think that's why, to your point, Ivana, it needs people both inside and outside the system that can see the challenges and and want to do something about them to really affect that change.
• 6:51
  SPEAKER_03: So that's a very consulting-y answer, isn't it?
• 6:53
  SPEAKER_03: To uh to the question.
• 6:57
  SPEAKER_01: I think there's different aspects.
• 6:58
  SPEAKER_01: I really agree with that, Alex, right?
• 6:59
  SPEAKER_01: If I do systems, systemic constellations work, I work with teams uh and I don't think people are A bad or B m ill-intentioned at all, right?
• 7:09
  SPEAKER_01: And that's also a piece why I like consulting, because I can walk into a company and say, your team seems awfully exhausted.
• 7:15
  SPEAKER_01: Right.
• 7:16
  SPEAKER_01: And I can say maybe I'm wrong.
• 7:17
  SPEAKER_01: You know, farm at the moment, people are carrying more and more jobs, and theoretically AI is helping, but practically it's adding complexity.
• 7:25
  SPEAKER_01: And so, you know, if people were sitting by a pool drinking a daiquiri and having a chat about stuff, they'd be more relaxed and it will be more fun.
• 7:32
  SPEAKER_01: But they'd have a lot of things that they have to do, and on top of that, there's maybe a transformation or a change or a new project or a new whatever it is.
• 7:38
  SPEAKER_01: I wrote about this, it's your nervous system at some point just says no, right?
• 7:41
  SPEAKER_01: It's a human reaction to being stretched all the time.
• 7:44
  SPEAKER_01: And so I think there's the human component of, I don't want to say fixing pharma.
• 7:48
  SPEAKER_01: I mean, you could look at banking, you could look at any industry, right?
• 7:51
  SPEAKER_01: It's when you have a lot of people with conflicting personal goals.
• 7:56
  SPEAKER_01: And if you put pharma into the global context right now, right, you have systems mirror each other.
• 8:02
  SPEAKER_01: So you've got the world is in chaos.
• 8:04
  SPEAKER_01: It feels okay because we're in Switzerland.
• 8:06
  SPEAKER_01: But I mean, generally, there is a lot, there's a lot of stuff going on that is unpredictable.
• 8:10
  SPEAKER_01: The markets are unpredictable.
• 8:12
  SPEAKER_01: I know a lot of 50 plus year olds who've lost their job, so that means the ones who still have a job are probably going, let me think, do I want to speak to this?
• 8:19
  SPEAKER_01: Possibly not.
• 8:20
  SPEAKER_01: And that's not because they are bad people, but because they're going, I have a mortgage, I've got children.
• 8:24
  SPEAKER_01: If I lose my job now, at least in this market, I probably won't get another one.
• 8:27
  SPEAKER_01: So there's a lot of different variables, and that's to your point, Alex, needs to be, you need to have a system that accommodates human variations and the world at large.
• 8:37
  SPEAKER_01: And that's not a farmer problem either.
• 8:39
  SPEAKER_01: One of my bosses once said it's like a very big ship, right?
• 8:41
  SPEAKER_01: It doesn't turn fast.
• 8:42
  SPEAKER_01: You've got hundreds of thousands of people in these companies.
• 8:45
  SPEAKER_01: You've got processes, regulations, compliance, IT systems, all of that.
• 8:50
  SPEAKER_01: You can't just change that.
• 8:51
  SPEAKER_01: And even if you did just change it, you don't know what you're going to change it to to make it work.
• 8:55
  SPEAKER_01: So I think fixing pharma, I love the big image.
• 8:58
  SPEAKER_01: It's like, let's do something like Skyme Everest.
• 9:00
  SPEAKER_01: I look at it more like Gorilla Activities once.
• 9:03
  SPEAKER_01: I real that wasn't a good word, and I can't think of a better one.
• 9:06
  SPEAKER_01: Maybe it's like gorilla farming, but it's I think if you interact with one or two teams and that makes things better for that team, and they start modeling what's better for them with other teams, and it spreads in little bits.
• 9:17
  SPEAKER_01: And that to your point, Ivana, is of course you do need people inside the company who care, but who care and have enough resilience because that's the other bit, right?
• 9:24
  SPEAKER_01: A lot of people might care, but they're worn down and they just don't have a capacity.
• 9:28
  SPEAKER_01: So to hold space, you need capacity to hold space with teams.
• 9:32
  SPEAKER_01: And I do this a lot with teams, you know, you have the official communication and then you've got what's actually happening underneath the surface.
• 9:39
  SPEAKER_01: And I did a video about this recently about the invisible problems, the ones that you you can feel are there, you know, the ones that you talk about with your friend at the coffee machine and you say, Did you know that this is happening?
• 9:49
  SPEAKER_01: And then you go into a meeting and you have a very nice conversation.
• 9:52
  SPEAKER_01: You don't talk about the thing that's happening because you know there's either no solution or nobody wants to talk about it.
• 9:56
  SPEAKER_01: Those things, I think when people are more exhausted, these things get encapsulated and don't get talked about.
• 10:01
  SPEAKER_01: When a whole team knows that something's not working, but they don't know how to get a resolution.
• 10:06
  SPEAKER_01: I don't know how somebody who's part of the problem holds the space.
• 10:08
  SPEAKER_01: So I think that having somebody external to come in and just go, I'm holding a safe space.
• 10:13
  SPEAKER_01: I'll give you an example.
• 10:14
  SPEAKER_01: I ran a workshop in the UK and and it was fabulous.
• 10:16
  SPEAKER_01: The team spent 15 minutes not engaging.
• 10:19
  SPEAKER_01: So they spent 15 minutes looking for charges and trying to plug their phones in.
• 10:22
  SPEAKER_01: And it was just, it was such a human moment because they were worried to start talking about this because they were worried about what might happen.
• 10:29
  SPEAKER_01: And I just reflected that back.
• 10:30
  SPEAKER_01: I said, you know, it's interesting that we're here to solve a problem, and none of you kind of want to get started.
• 10:35
  SPEAKER_01: I wonder whether it is you're worried because you've stuck on this for so long.
• 10:38
  SPEAKER_01: And I'm pretty fearless, so I don't not care.
• 10:41
  SPEAKER_01: But anything can happen in a room.
• 10:42
  SPEAKER_01: I'm totally happy because as long as people are still passionate, they still care.
• 10:46
  SPEAKER_01: And if they care, you can still fix it.
• 10:49
  SPEAKER_01: So uh and I think when people feel that, they feel they're not, you know, you're you're not in competition with them for anything.
• 10:54
  SPEAKER_01: All I'm there for is to hopefully make their working life a bit better.
• 10:58
  SPEAKER_01: And I actually care about the down the people, so that's all I want to do.
• 11:02
  SPEAKER_01: And I think when people feel that's authentic, they trust you easily.
• 11:05
  SPEAKER_01: So that's another reason why I like doing it.
• 11:06
  SPEAKER_03: That was a very, very long answer to your question, but you'll then have one of the things in there that struck me and is quite interesting is we like metaphors here.
• 11:16
  SPEAKER_03: It made me think about different hats that people wear and the permissions associated with wearing a particular hat, right?
• 11:23
  SPEAKER_03: And I think this is the reason that consultants are brought in occasionally, and it can be exactly the same person.
• 11:28
  SPEAKER_03: You can have someone in an organization who then leaves, becomes a consultant, they've got this different hat on.
• 11:34
  SPEAKER_03: And actually it's exactly the same person, but the organization will tolerate very different things from them.
• 11:39
  SPEAKER_03: And actually, one of the powerful things about being external is that generally organizations will accept a much greater degree of truthfulness from you that maybe isn't accepted when you have your internal sitting in the organization hat on.
• 11:52
  SPEAKER_03: And those are also very human interpersonal dynamics, actually, that are going on about meeting unwritten rules of expectation, essentially.
• 12:01
  SPEAKER_03: Does that also resonate with you both as well?
• 12:02
  SPEAKER_03: Is that do you think that's something a part of what's going on?
• 12:05
  SPEAKER_03: It's about roles, right?
• 12:06
  SPEAKER_01: That is such a huge part of systems.
• 12:08
  SPEAKER_01: What role are you holding in the system?
• 12:10
  SPEAKER_01: Of course, as you come in as a consultant, I think that's it's critical.
• 12:13
  SPEAKER_01: And I I I've worked with companies who say we want to give you an email address internally.
• 12:16
  SPEAKER_01: I said, You can't.
• 12:16
  SPEAKER_01: If you give me an email address internally, I I'm integrated in your system, at which point I'm no longer in the position where I can be perceived as neutral or outside your system at all.
• 12:24
  SPEAKER_01: And so, yeah, I think the role being very clear on that, and I think that can be challenging if you go outside and you come back in, you know the organization well.
• 12:32
  SPEAKER_01: You have to be very clear on I am in a different role, I have a different position.
• 12:36
  SPEAKER_01: And if you don't know the organization, it's easy because you're not part of it.
• 12:39
  SPEAKER_01: But you see that also with people who change roles in organizations a lot, right?
• 12:44
  SPEAKER_01: Let's say you get promoted, you have to actively say, I used to be the expert for whatever, and now I am the boss of the expert for whatever.
• 12:53
  SPEAKER_01: But you see, people struggle with this all the time to say, I'm now handing off the responsibility for whatever to the next person.
• 13:00
  SPEAKER_01: And I'm not going to micromanage their work because it makes me feel more secure to do that, because I'm not actually sure what I'm doing now.
• 13:07
  SPEAKER_01: Companies don't typically help people really to say you've changed, because it's a different title, but actually saying, right, the different title is a different behavior, it is different activities, is different responsibilities, different accountability.
• 13:19
  SPEAKER_01: And people I've seen often they carry the other stuff with them.
• 13:24
  SPEAKER_01: And because, of course, they like doing that and they were good at it, it doesn't give the other the new person the freedom to take the role fully.
• 13:29
  SPEAKER_01: So I think the awareness of roles is really important.
• 13:32
  SPEAKER_01: When you hire somebody in, that's a commitment to me.
• 13:36
  SPEAKER_01: It's a commitment to say what's working at the moment isn't actually working.
• 13:39
  SPEAKER_01: So the methods we've been doing don't actually address what we need to address.
• 13:43
  SPEAKER_01: So maybe there's a sense of unease, maybe it's just a technical problem, or maybe it is the teams that can't speak together.
• 13:49
  SPEAKER_01: And you notice that those teams have to speak together, but maybe you've got people heading up those teams who don't like each other or don't understand each other.
• 13:56
  SPEAKER_01: And that's the other thing, right?
• 13:57
  SPEAKER_01: It's often cultural.
• 13:58
  SPEAKER_01: I had this with American teams that say, I'm working with the Germans, they're very, very direct and they're not friendly.
• 14:02
  unknown: Right.
• 14:03
  SPEAKER_01: And the Germans would say, that's just how we communicate, right?
• 14:05
  SPEAKER_01: Europeans on the contrasting side have said, Americans just write, hi, this is John, I need X.
• 14:11
  SPEAKER_01: By tomorrow, warm regards.
• 14:13
  SPEAKER_01: And the Europeans would say, What about how's it going?
• 14:15
  SPEAKER_01: What's the weather like?
• 14:17
  SPEAKER_01: There was no ill intention on any side.
• 14:19
  SPEAKER_01: But depending on the culture and the personalities involved, the roles are important and the expectation that you and no with the internal rules and behaviors and whatever are sort of suspended because they're bringing in a new tool, right?
• 14:31
  SPEAKER_01: They're bringing in a new tour.
• 14:33
  SPEAKER_01: Typically, you pick a consultant for personality too, which is kind of practical because easier to go, do I want to sign up for what I'm seeing, or does this look like it's gonna be unpleasant, so I'm not gonna sign up for it?
• 14:42
  SPEAKER_01: Or does it look like it's gonna be effective?
• 14:43
  SPEAKER_01: So I think that's they choose that to help.
• 14:46
  SPEAKER_01: If you came in and did the same things, I've I have had people say to me, I actually had somebody write on a conference, they wrote in anonymous feedback, which I love.
• 14:54
  SPEAKER_01: It was Isabel is a consultant and has no right to have her own opinion.
• 14:59
  SPEAKER_01: Wow.
• 15:00
  SPEAKER_01: Challenge the participants, and I'm saying, Who are you?
• 15:03
  SPEAKER_01: I'm happy to talk to you about this because actually, if I have no personal opinion, and it's not even my opinion, it's I'm sharing, it's sort of like a mirror, right?
• 15:10
  SPEAKER_01: I'm reflecting back what I see, and that of course is also reflected back by who I am and my filters and my culture and my whatever.
• 15:17
  SPEAKER_01: So it's always an imperfect picture, and it only becomes a perfect picture if the teams engage with you and the leaders engage with you, and then you all bring in your imperfect pictures and you go, This is what we're seeing, what does that mean?
• 15:28
  SPEAKER_01: But if all I do is go, Ivana, what you've just said is so fantastic.
• 15:32
  SPEAKER_00: Yeah.
• 15:32
  SPEAKER_02: That being said, Isabel, I I do encounter that.
• 15:35
  SPEAKER_02: Like we are kind of painting the consultant role as the truthsayer, a person who can actually change uh things in in an organization.
• 15:42
  SPEAKER_02: I have definitely experienced having consultants work for me who are more worried about getting the next project or being renewed than telling me the truth.
• 15:50
  SPEAKER_02: So just sliding that perspective in there.
• 15:53
  SPEAKER_02: No, no, but that is probably a sensible consultant.
• 15:57
  SPEAKER_01: Right, let's say a sensible consultant in the sense of where's my next meal coming from?
• 16:01
  SPEAKER_01: I guess that the way that I work, and this is not that they don't, but I just I want to fix things, right?
• 16:05
  SPEAKER_01: I have a research background, I'm like, okay, this is super interesting.
• 16:08
  SPEAKER_01: What's not working here?
• 16:09
  SPEAKER_01: How can we fix it?
• 16:10
  SPEAKER_01: And it's not about telling people dishonestly, it's just this is what I'm seeing, which may or may not serve you.
• 16:17
  SPEAKER_01: And then you might say to me, Yes, but you're missing this bit, and then you open another cupboard and we go, well, let's go and have a look in that cupboard.
• 16:23
  SPEAKER_01: You're like, okay, well, that changes the context.
• 16:25
  SPEAKER_01: And it's not the consultant knowing, right?
• 16:27
  SPEAKER_01: It's the consultant being able to say, are there any cupboards we haven't looked in yet?
• 16:31
  SPEAKER_01: Are there any things we've forgotten?
• 16:33
  SPEAKER_01: I mean, just the classic one on Alex's comment before on roles, is sometimes when you see this a lot in systems, if you fire somebody and then you replace that person, often what happens is the same person keeps getting fired in the same rock.
• 16:43
  SPEAKER_01: Or a team will say, you know, John's really annoying, and you'll and then you discover actually John's sort of carrying something for the system.
• 16:49
  SPEAKER_01: It's a bit like in children when you have groups of children that don't like somebody, and then you say, Well, John's really difficult, we'll get rid of him, and then Susan becomes really difficult.
• 16:56
  SPEAKER_01: And you start thinking, sometimes it's the person, sometimes it's the context, sometimes it's a system, and and all of it is serving something.
• 17:03
  SPEAKER_01: So I don't know, I don't actually worry about getting a next position.
• 17:07
  SPEAKER_01: It's more that I want to fix the one that I'm helping with to the best of my ability.
• 17:11
  SPEAKER_01: And yeah, I've never thought about that.
• 17:12
  SPEAKER_01: I'm not gonna think about that now then.
• 17:13
  SPEAKER_01: And maybe I should say this is really fabulous more.
• 17:16
  SPEAKER_01: Please don't.
• 17:19
  SPEAKER_03: I think this starts to get at another point, which is there's also no perfect role here, right?
• 17:24
  SPEAKER_03: I mean that there's advantages to being uh external, and there's ways that you can make the best use of those advantages, or make the worst use of those advantages, right?
• 17:33
  SPEAKER_03: And the same internally.
• 17:35
  SPEAKER_03: And I think this is why you also need internal champions, because as an external, there's only so much influence and power and decision-making ability that you have.
• 17:45
  SPEAKER_03: And there will always be people, like your example, Isabel, who says, Well, these consultants aren't allowed an opinion, actually.
• 17:51
  SPEAKER_03: Why should we listen to them?
• 17:53
  SPEAKER_03: And so there's there's the need also for people internally to champion projects, but I think I like your position about fearlessness.
• 18:00
  SPEAKER_03: There needs to be a little bit of fearlessness to, in the right way, at the right points, work in opposition to how the system wants you to work to get things done.
• 18:09
  SPEAKER_03: And for both sides, right?
• 18:10
  SPEAKER_03: Do be dedicated to getting the right thing out rather than simply doing what is expected.
• 18:16
  SPEAKER_02: So I want to take us back to one of the things you mentioned in the very beginning, Isabel, and that is the lack of capacity with people to actually be able to change.
• 18:27
  SPEAKER_02: And this makes me think of a metaphor of people working in pharma just already have had a big buffet, and now we're offering them some dessert and saying, ooh, this is also delicious.
• 18:39
  SPEAKER_02: This is like the best meal you haven't had yet, and they're already full.
• 18:42
  SPEAKER_02: So what is it that pharma has already overeaten on and where's the appetite gone?
• 18:47
  SPEAKER_01: Well, I think they've overeaten I'll tell you in a minute.
• 18:49
  SPEAKER_01: There's an extra thing you could do, and it's delicious.
• 18:52
  SPEAKER_01: Like here's an extra thing that means you have to, you know, eat broccoli for the next five days.
• 18:56
  SPEAKER_01: You're framing it as something that people want to do.
• 18:59
  SPEAKER_01: I think that's beautiful.
• 19:01
  SPEAKER_01: I'm not sure it's it's what I see, but so what have people what are people I think overeaten on is Pharma companies are pretty complex, right?
• 19:09
  SPEAKER_01: There's people, there's processes of systems.
• 19:12
  SPEAKER_01: If you're an employee in a in an affiliate, you have different systems, different reporting lines, you have dotted lines, you've got strict reporting lines, and then you've got the local authorities, and that's already quite a lot to hold for a human being.
• 19:24
  SPEAKER_01: I think if you came along and said here's a cupcake, they might say, Okay, I'll eat the cupcake, that looks delicious.
• 19:29
  SPEAKER_01: But typically it's here's the ingredients, including some cyanide and some arsenic and other things, and you can make a cupcake, but you've got to figure out how to make it, and you've got to pick the right ingredients and you've got to design it and find another.
• 19:40
  SPEAKER_01: If it was just here's a cupcake or here's a dessert, people would probably say, I can fit that in.
• 19:46
  SPEAKER_01: But it's adding a lot of structural complexity on top of existing complexity.
• 19:51
  SPEAKER_01: And I think thinking about that in a food image, if you keep adding things to the buffet and never removing things away, some things get old, some things are no longer edible.
• 20:00
  SPEAKER_01: And maybe if you just looked at your buffet from time to time and said, Okay, do you know what we're going to take these things away so that people have less choice, but the choice they have makes sense and they're not confused by choice, and then they'll have space to do whatever else is coming.
• 20:13
  SPEAKER_01: And when I talk to colleagues in Pharma, they tell me we keep adding complexity, but then we're nobody wants to strip things away because we're worried that we might lose something.
• 20:23
  SPEAKER_01: So we keep on adding and not taking away.
• 20:25
  SPEAKER_01: And maybe that's the point that you've made, right?
• 20:27
  SPEAKER_01: You're overeaten on complexity, and nobody has the capacity to say, hang on a second, we're going to strip the buffet back to a chicken and a meat dish and a dating dish.
• 20:36
  SPEAKER_01: And so you're overloaded.
• 20:37
  SPEAKER_01: And that take that needs the capacity.
• 20:40
  SPEAKER_01: Again, I think that's something I've seen in my personal life, but also in business, that it's very easy to think, if I just do this faster, right?
• 20:47
  SPEAKER_01: When I used to work in farm, I just feel I'll just add this project and do all the other ones faster.
• 20:51
  SPEAKER_01: And then I'll do another one, I'll do that one faster too.
• 20:54
  SPEAKER_01: At the point where I never actually took the time to step back, sit for half an hour and go, does this make sense?
• 20:59
  SPEAKER_01: Right.
• 21:00
  SPEAKER_01: And that's in personal life too.
• 21:01
  SPEAKER_01: You think, think example, I was going to go to Art Basel, and I thought I had a barbecue at three and a dinner at seven, and I thought maybe I can cycle into the city in 30 minutes, go to art for one and a half hour, cycle back, make a salad, go to this.
• 21:14
  SPEAKER_01: And I just thought, no, this is not a sensible, it's not a sensible plan.
• 21:18
  SPEAKER_01: I know I'm not alone in that because it's sort of going, what can I fit into the day?
• 21:22
  SPEAKER_01: Once people are super overloaded, the only, the only often the only impetus is to go, if I go faster, I can still make it work instead of, and that's actually my one of my old bosses once it slower is faster.
• 21:35
  SPEAKER_01: Right.
• 21:35
  SPEAKER_01: So sometimes just spending, I've I've said to teens, look, if we spent a day, can we take a day just to map out what people are feeling, what your processes are, what isn't working, what's blocking you?
• 21:45
  SPEAKER_01: And then we can maybe unlock some capacity by getting rid of stuff.
• 21:49
  SPEAKER_01: But people, when they're in that sort of flight fight mode of living, which I think a lot of people in pharma are, the thought of spending half a day mapping anything just makes them really, really scary.
• 22:00
  SPEAKER_01: Because they go, I haven't got half a day.
• 22:01
  SPEAKER_01: What do you I haven't I can't give you half a day because they can't see the upside anymore.
• 22:05
  SPEAKER_01: So I think that's a combination of too much complexity, some exhaustion, and when you're exhausted, you can't really make hard decisions as easily as you could if you were super rested.
• 22:15
  SPEAKER_01: Yeah.
• 22:15
  SPEAKER_02: Does that answer your question?
• 22:16
  SPEAKER_02: I I just want to summarize what you said, Isabel, because I think that was great that if we gave Pharma a cupcake, they would say, Yes, delicious, let's let's have the dessert.
• 22:26
  SPEAKER_02: But instead we are asking them to invent the ingredients and figure out how to make the cupcake before they can have it.
• 22:35
  SPEAKER_02: Yep.
• 22:36
  SPEAKER_02: That that's a really uh beautifully put a metaphor.
• 22:39
  SPEAKER_00: Thank you for the serving up the cupcake, Ivana.
• 22:43
  SPEAKER_03: Well, but I I also like the point about a and and I think this is also the nature of humans, right?
• 22:49
  SPEAKER_03: When we when we see a problem, we tend to want to create something to fix that problem.
• 22:55
  SPEAKER_00: Yep.
• 22:56
  SPEAKER_03: But sometimes what we need to do is maybe take something away instead.
• 23:01
  SPEAKER_03: But that's not so much our natural way of being in terms of problem solving.
• 23:06
  SPEAKER_00: That's true.
• 23:07
  SPEAKER_00: It isn't, is it?
• 23:09
  SPEAKER_01: I mean it's like that's why Mary Condo was so successful.
• 23:14
  SPEAKER_01: Yeah, yeah.
• 23:16
  SPEAKER_01: People's natural impulse is to collect or accumulate or sometimes overcomplicate rather than say, let's strip this back to the you know, unless you're a car mechanic.
• 23:25
  SPEAKER_01: In which case that might be what you do.
• 23:26
  SPEAKER_01: But yeah, you're right.
• 23:27
  SPEAKER_01: If you look at back to your five things at the beginning, right martial innovation, compliance, regulatory, and I pick up the fifth one again.
• 23:35
  SPEAKER_03: Manufacturing.
• 23:36
  SPEAKER_03: Everyone's favorite.
• 23:38
  SPEAKER_01: Everyone's favorite.
• 23:39
  SPEAKER_01: Well, I mean, manufacturing is a good example because it's got an engineering sort of line to it, right?
• 23:43
  SPEAKER_01: They are very structured, they are very regulated.
• 23:46
  SPEAKER_01: There are things that make sense, there are things that don't make sense, and you adapt things and everything's written down in SOPs and it's very compliant.
• 23:52
  SPEAKER_01: In a lot of other areas of the business, that's not how things work.
• 23:56
  SPEAKER_01: And I think maybe that's the other bit.
• 23:57
  SPEAKER_01: There's a bit about the human resistance to imposed rules.
• 24:02
  SPEAKER_01: So I I had this when I started working, my job was well, loads of different jobs.
• 24:06
  SPEAKER_01: But one of the top conversations I often had was people were telling me that I was reducing their creativity.
• 24:13
  SPEAKER_01: And back then I used to say, well, if you wanted to be Rango, you probably shouldn't be working in a pharma company, and that obviously was not a helpful thing to say.
• 24:20
  SPEAKER_01: It was many years ago, and I'm just gonna cut myself some slack for that, but it wasn't helpful.
• 24:25
  SPEAKER_01: The image I used was you have a stamp, you know, you've got a letter you want to post.
• 24:30
  SPEAKER_01: You can spend 25 minutes figuring out where to stick the stamp.
• 24:34
  SPEAKER_01: Does it add value to your letter?
• 24:35
  SPEAKER_01: No.
• 24:36
  SPEAKER_01: So let's say you have a rule, you go, the stamp goes top right, then the thingy goes in the middle, the answer, your address goes on the back.
• 24:42
  SPEAKER_01: And then you can spend 25 minutes going, what can I write in this letter that's going to be really interesting?
• 24:48
  SPEAKER_01: And so when people would say to me, You're imposing rules, I'd say, but the compliance and the structural perspective is actually stripping away stuff that's just a waste of your time to reinvent all the time, so that you can focus on the creative bit.
• 25:01
  SPEAKER_01: So it's actually freeing up your resource.
• 25:02
  SPEAKER_01: But first pass, people don't often feel that.
• 25:05
  SPEAKER_01: They just think, oh, here's another rule or here's another limitation.
• 25:08
  SPEAKER_01: Not this limitation will free me up to do other things.
• 25:10
  SPEAKER_01: And I think that's that's why you know change efforts are sometimes hard, because unless you really engage the teams you're working with, there is that feeling of somebody's decided what's good for me and I don't like it, and that's a very normal human reaction too.
• 25:22
  SPEAKER_02: Very good.
• 25:23
  SPEAKER_02: I actually think we can start moving on to the game show round.
• 25:29
  SPEAKER_02: And today I am going to do something crazy and actually let you pick between two potential topics.
• 25:38
  SPEAKER_02: Wow.
• 25:39
  SPEAKER_01: Have you ever heard the Hitchhiker's Guide to the Galaxy?
• 25:42
  SPEAKER_01: Yes.
• 25:42
  SPEAKER_02: Yes.
• 25:43
  SPEAKER_01: You remember Marvin the Paranoid Android?
• 25:45
  SPEAKER_03: Yes, I see why this is going.
• 25:47
  SPEAKER_01: Marvin the Paranoid said, I'm not gonna like it.
• 25:51
  SPEAKER_01: I know whatever it is, I'm not gonna like it.
• 25:53
  SPEAKER_02: But yeah, go hit me.
• 25:55
  SPEAKER_02: Just to summarize, what is the game show round?
• 25:57
  SPEAKER_02: The game show round is a quiz round consisting of three questions, and that you will get options for what the answers could be to those questions.
• 26:05
  SPEAKER_02: But today I am going to give you two potential topics to choose from.
• 26:10
  SPEAKER_02: So it starts out with a quiz straight off the bat.
• 26:13
  SPEAKER_02: Quiz for the quiz.
• 26:14
  SPEAKER_02: Yeah, nice.
• 26:15
  SPEAKER_02: So I can either serve you a quiz of how couch is this trial, where you can tell me, I'm going to give you examples of clinical trials, and you can tell me to which degree participants have to show up at sites for that trial, or whether they could stay on their couch, or I can give you a quiz about the sliding doors in biopharma, where I will take you through a number of decisions where the pivotal decisions were either the drug succeeded or it failed, and I'll have you make those decisions on behalf of the biopharmers, and then I'll tell you what they did and how that worked out.
• 26:50
  SPEAKER_02: So those are your choices couches or sliding doors.
• 26:54
  SPEAKER_01: Frankly, I know nothing, but I'm curious.
• 26:57
  SPEAKER_01: I'm more curious about the sliding doors.
• 26:59
  SPEAKER_01: Sliding the couches might be easier to guess, but the sliding doors is one I'm curious about.
• 27:04
  SPEAKER_01: So we're just gonna go with sliding doors, and you're gonna tell me what happens and I'm gonna learn things.
• 27:08
  SPEAKER_03: Yeah, let's be fairly sliding doors.
• 27:10
  SPEAKER_02: Excellent.
• 27:10
  SPEAKER_02: Sliding doors.
• 27:12
  SPEAKER_02: Good.
• 27:12
  SPEAKER_02: This quiz is all about could more drugs have made it to make difference in patients' lives had pharmaceutical companies made a different decision.
• 27:22
  SPEAKER_02: And this is based on a long, long article that I will also link to in this episode.
• 27:28
  SPEAKER_02: I recommend reading it.
• 27:29
  SPEAKER_02: It's super fascinating.
• 27:30
  SPEAKER_02: In the article, they go through 12 different examples of decisions.
• 27:35
  SPEAKER_02: I'm only going to give you three.
• 27:37
  SPEAKER_02: I think 12 will be a struggle in the time we have.
• 27:39
  SPEAKER_02: That's great, yeah.
• 27:40
  SPEAKER_02: Yeah, yeah.
• 27:42
  SPEAKER_02: Good.
• 27:42
  SPEAKER_02: So the first example we are back in January 2016, and we are considering the Novonordisk semagrotide obesity step trial.
• 27:54
  SPEAKER_02: And the question is, should Novo Nordisk invest 1.5 billion in a dedicated obesity phase three program for semagrotide 2.4 milligrams, despite that the obesity drug market was regarded as a commercial wasteland.
• 28:11
  SPEAKER_02: And your options are yes, invest 1.5 billion or divest.
• 28:16
  SPEAKER_02: There's no money in obesity.
• 28:17
  SPEAKER_02: That's a kind question.
• 28:18
  SPEAKER_01: Well, I would say yes, invest, but I'd also say that if you'd asked me that in 2016, I would have gone, do we really need to put 1.5 billion in?
• 28:26
  SPEAKER_01: Could we maybe start with something smaller?
• 28:28
  SPEAKER_01: Can we do uh something?
• 28:29
  SPEAKER_01: Okay, yeah, I would say yes.
• 28:30
  SPEAKER_03: Alex?
• 28:31
  SPEAKER_03: Yeah, I mean Are you playing too?
• 28:33
  SPEAKER_03: Good.
• 28:33
  SPEAKER_03: Yeah, yeah, no, we're both playing.
• 28:34
  SPEAKER_03: No, I mean, very easy to make the decision now, right?
• 28:37
  SPEAKER_03: Because the obesity market is incredibly huge.
• 28:40
  SPEAKER_03: But how would you know that in 2016?
• 28:43
  SPEAKER_03: I mean, I can only pick option A because we all know what's happened over the past few years.
• 28:48
  SPEAKER_03: What's an interesting question is how you would have the vision to pick option A in 2016, but maybe that's a later episode.
• 28:56
  SPEAKER_01: That's the good question, right?
• 28:57
  SPEAKER_01: It would be, Isabel, if you were in 2016 and that had been your situation, what would you have done?
• 29:04
  SPEAKER_01: At which point, possibly I would have said, that seems like an incredible amount of money, what's the data for it?
• 29:09
  SPEAKER_01: But then, just to I know you probably want to hop on, but I'm thinking, you know, we've been investing in a lot of uh nervous system disorders that have just every trial's failed.
• 29:18
  SPEAKER_01: They fail and they fail and people try again.
• 29:20
  SPEAKER_01: So Alzheimer's MS, there's a lot that fails.
• 29:24
  SPEAKER_01: Or chronic fatigue syndrome that people don't even try to fix.
• 29:27
  SPEAKER_01: And if we are looking even in 2016, it's a bit like when I started at Roche in 2006.
• 29:32
  SPEAKER_01: I looked, I said, I'm I'm just a medical doctor, what do I know about anything?
• 29:36
  SPEAKER_01: In 2006, the writing was on the wall, the population's getting older, the population is getting multimorbid, the population's gonna have more cancer.
• 29:44
  SPEAKER_01: Back then, Roche was one of the leading companies, still is, of course.
• 29:47
  SPEAKER_01: But I remember saying to the teams, this is obviously gonna be a huge market, which sounds kind of idiotic saying it now, but this is 2006.
• 29:55
  SPEAKER_01: And I said, We're leading, but there's gonna be a lot of competition, so we need to make sure that we stay competitive with whatever it, you know, not whatever it takes, but with obviously the products, but also with the support systems around it as other people come in.
• 30:06
  SPEAKER_01: And so if you look at 2016, the the world obesity endemic, pandemic, I don't know what it's called, I forget it's that that's been going on, and that the writing's been on the wall for that too.
• 30:15
  SPEAKER_01: Wouldn't you say 2000?
• 30:16
  SPEAKER_01: It's only 10 years, and we've in the last 30 years, the world's population has been increasing in size, diabetes, metabolic syndrome's been a problem in every market, Indian markets, uh, the UK's got a huge problem.
• 30:28
  SPEAKER_01: So, what the writing was on the wall, but it was the question of are you willing to put your money where the numbers are and take risks?
• 30:34
  SPEAKER_03: The risk of making this answer 10 minutes as well.
• 30:36
  SPEAKER_03: I'll just add one more thing, which is because we're talking about the time frame, but we're also talking specifically about Nobo Nordisk, which I think is an interesting choice because I seem to remember around that time someone can shout at me about the dates if they really want to.
• 30:50
  SPEAKER_03: I remember that Nobo had a very interesting, at least stated, change in what they were intending to do as a company.
• 30:58
  SPEAKER_03: Because up until whenever this decision was, they'd been an insulin company, we're a diabetes company.
• 31:03
  SPEAKER_03: Yeah.
• 31:03
  SPEAKER_03: But at some point they set a specific goal, which is to say, well, no, we're not just an insulin company.
• 31:08
  SPEAKER_03: We are a company aimed at helping to prevent, cure, minimize diabetes as a condition.
• 31:15
  SPEAKER_03: And in that context, it's a very different question.
• 31:19
  SPEAKER_03: Because if that is your aim and obesity is such a leading cause of type 2 diabetes, then spending investing that sort of money makes a lot more sense.
• 31:28
  SPEAKER_03: So I think it's a nice example of where having a big, specific and uh deliberate goal can really work out for you over the long term.
• 31:36
  SPEAKER_02: Yeah, yeah.
• 31:37
  SPEAKER_03: Presuming we're right.
• 31:39
  SPEAKER_02: Yeah, yeah.
• 31:39
  SPEAKER_02: And you are, of course, very right, both of you.
• 31:42
  SPEAKER_02: The answer is invest because that's 1.5 billion investments led to more than 50 billion.
• 31:48
  SPEAKER_02: So uh pretty good.
• 31:49
  SPEAKER_02: Good call on that one, but so hard in the time.
• 31:52
  SPEAKER_03: We can't go back and make that investment ourselves now, can we?
• 31:55
  SPEAKER_03: That would be like a 50 billion.
• 31:57
  SPEAKER_03: Time machine.
• 31:57
  SPEAKER_00: Have you got a time machine?
• 31:59
  SPEAKER_03: Yeah.
• 32:00
  SPEAKER_02: All right.
• 32:00
  SPEAKER_02: Are we ready for the next question?
• 32:03
  SPEAKER_01: Yeah, have you got a time limit on the answers?
• 32:05
  SPEAKER_01: Because then I'll just time what you want.
• 32:07
  SPEAKER_01: I will stop within the time.
• 32:08
  SPEAKER_01: You can tell me you've got 30 seconds.
• 32:10
  SPEAKER_03: We need a we need a bell.
• 32:12
  SPEAKER_02: I need a bell.
• 32:13
  SPEAKER_02: That's it.
• 32:14
  SPEAKER_02: Okay, so this is more recent.
• 32:15
  SPEAKER_02: We are in January 2022.
• 32:18
  SPEAKER_02: Yeah.
• 32:19
  SPEAKER_02: So we have the Sarepta and Elevitus filing.
• 32:23
  SPEAKER_02: And the question is should Sarepta file Elevitus gene therapy for DMD, despite missing the functional endpoint leaning on biomicrodystropin data.
• 32:33
  SPEAKER_02: And your options are file or don't file.
• 32:39
  SPEAKER_01: But Ivana, that that that assumes that I know anything about the drug, anything about anything, based on not knowing anything about the drug or the indication that we're looking at or anything else.
• 32:51
  SPEAKER_01: This is a I don't know.
• 32:53
  SPEAKER_01: I would need a little bit of a here's five sentences on the general market, the indication that, you know, whatever.
• 32:58
  SPEAKER_01: And then I could go probably do this, but I don't know.
• 33:01
  SPEAKER_01: So sorry, can't answer that.
• 33:03
  SPEAKER_03: What I would say is that to me, that seems like a real uphill battle, depending on actually what the the clinical validation status of that of the follow-up endpoint is.
• 33:13
  SPEAKER_03: I mean, missing your primary endpoint and trying to rely on on secondary endpoints is always gonna be tough.
• 33:19
  SPEAKER_03: However, it's much, much easier if that backup endpoint is something that's already well validated and well established.
• 33:25
  SPEAKER_03: If it's a new one or or hasn't been well established, you're on much dodgier ground.
• 33:29
  SPEAKER_03: I'm just gonna take a leap though and uh on the basis of no information at all, say, no, that seems, for my taste, not knowing, too high risk.
• 33:37
  SPEAKER_03: But I would love to be proven wrong.
• 33:39
  SPEAKER_01: I'm just gonna add in because I had a quick look.
• 33:41
  SPEAKER_01: So of course it also depends on whether it's an indication that's flooded in the market or whether there's nothing else competing, and therefore the upside potential for patients is still given, even if you missed the first one, but the secondary endpoint is relevant.
• 33:56
  SPEAKER_01: I still don't know what the answer is, but I'm waiting for around.
• 33:58
  SPEAKER_01: Yes.
• 33:59
  SPEAKER_02: And well, the first one was easy, so I had to come up with a more difficult one.
• 34:04
  SPEAKER_02: Oh so they did file and they did get accelerated approval from the FDA in May 2023, but it has been a mixed outcome because once they entered the market, the data has been mixed.
• 34:17
  SPEAKER_02: So it is uh unclear whether more research perhaps it would have been beneficial.
• 34:21
  SPEAKER_01: But then they can do a phase four, right?
• 34:23
  SPEAKER_01: I mean, it's not as if you put it in accelerated approval, you do post-marketing studies anyway.
• 34:28
  SPEAKER_01: That's not totally surprising that that's what they'd be facing right now, right?
• 34:32
  SPEAKER_01: So interesting.
• 34:33
  SPEAKER_01: And it is actually just doing another longer trial before you file versus in this population getting it out there and then monitoring really carefully whether there's a validation for it or not.
• 34:44
  SPEAKER_01: I think you could argue which is that you know what makes more sense.
• 34:47
  SPEAKER_01: Have market access and pricing is going to be very dependent on that, right?
• 34:50
  SPEAKER_01: So if they miss the primary endpoint, get it into the market.
• 34:53
  SPEAKER_01: There will be a lot of scrutiny on which patients we give it to, which patients we pay for.
• 34:57
  SPEAKER_01: So I don't know if it benefits if it ends up benefiting, let's say, 40% of the patients in an area where there's nothing else, I'd still say it wasn't a bad decision.
• 35:05
  SPEAKER_01: That's the clinical patient focused thing.
• 35:07
  SPEAKER_01: And the slide effect for the others are obviously not dramatic.
• 35:10
  SPEAKER_01: It depends what what the downsides of it were.
• 35:12
  SPEAKER_03: Yeah, I mean, I'm also going to uh pick up a flag from my collection of little flags to wave that I have here, which is it's a nice example of approval is not adoption.
• 35:20
  SPEAKER_03: They're two very different things.
• 35:22
  SPEAKER_03: And I think it's something we come across quite often is that there's this presumption that your major barrier to market for drugs or devices is approval.
• 35:30
  SPEAKER_03: But unless you're really making the case for adoption as well in parallel and strongly, then actually getting approval can be the worst outcome because then you spent all of this money, you're on the market, but you're just not making your return on investment.
• 35:43
  SPEAKER_03: That's not to say that they made a bad decision.
• 35:45
  SPEAKER_03: And if they are, I would agree, if they are having patient value and patients are benefiting, then that's by far the most important thing here.
• 35:51
  SPEAKER_03: But it's a nice reminder that you need both of those pillars to succeed.
• 35:54
  SPEAKER_01: So I I like that point, Alex.
• 35:56
  SPEAKER_01: I love that observation.
• 35:58
  SPEAKER_01: I talked to a market access friend of mine once and he said, Look, people think getting approval is access to the market, but of course it's not.
• 36:03
  SPEAKER_01: You need reimbursement.
• 36:05
  SPEAKER_01: Then even with reimbursement, he says, I only consider market access to be achieved.
• 36:09
  SPEAKER_01: When a doctor has prescribed a product and a patient has taken that product compliantly, that for me is market access.
• 36:15
  SPEAKER_01: Everything else is just, you know, people walk into a shop and go, don't want this product, and they walk out again, and that doesn't count.
• 36:21
  SPEAKER_01: And the other piece, I don't know whether the adoption piece was the problem, or one was it actually the effects.
• 36:26
  SPEAKER_01: Because the adoption piece is one bit, but if it's actually not being prescribed because people don't trust it, or not being prescribed because actually it's having detrimental effects, then that's a very different thing.
• 36:35
  SPEAKER_01: But again, I know nothing.
• 36:36
  SPEAKER_01: I've got a friend who works in this company, I still know nothing about it, which makes me feel like a very bad friend.
• 36:42
  SPEAKER_03: I'm adding that sentence to my flag as we speak.
• 36:44
  SPEAKER_03: Market access is when trigger's been bagged and a patient has compliantly taken it.
• 36:48
  SPEAKER_03: I like that.
• 36:50
  SPEAKER_03: Out new subheading.
• 36:52
  SPEAKER_01: I designed a market access training course once, and I went to interview one of my friends who's been working market access for 25 years.
• 36:58
  SPEAKER_01: And he he just said that and I thought that's that it was years ago, but it stayed with me because it is that's it.
• 37:02
  SPEAKER_01: Right?
• 37:03
  SPEAKER_01: Just having it on just getting it on the market means nothing if nobody takes it, uses it, or finds it useful.
• 37:08
  SPEAKER_02: Yeah.
• 37:08
  SPEAKER_02: And also a lot of the challenges we're seeing in commercial, they may be properties of the drug and it's market fits that are very hard to fix in the commercial stage.
• 37:20
  SPEAKER_01: A market fit that's hard to fix.
• 37:22
  SPEAKER_01: Yeah.
• 37:22
  SPEAKER_01: But that that's a really, really super important point, right?
• 37:25
  SPEAKER_01: Because you you sometimes get a drug that's approved and then you look at the administration or something.
• 37:30
  SPEAKER_01: And that just happens to be not much better than the competitors.
• 37:34
  SPEAKER_01: So it ends up being a it's not a even if the product itself isn't bad, the administration's a problem, or something else is a problem, and it ends up being commercially viable, not because of the product itself, but because of the market, the healthcare system, how people administer drugs.
• 37:47
  SPEAKER_01: And that I think is one of those things why it's so important to go to the people at the pointy end of the business really early on, if you're an RD, and you have to integrate.
• 37:56
  SPEAKER_01: And again, this is against the silo model, right?
• 37:58
  SPEAKER_01: You have to integrate what are people hearing in the market, what do doctors need, but what are the gaps?
• 38:02
  SPEAKER_01: What don't they like about what's on the market right now?
• 38:05
  SPEAKER_01: And how do we flow that into obviously the RD piece, but then the clinical trial piece?
• 38:11
  SPEAKER_01: And I know that we do this, you obviously engage patients too now, but it's still, I think, because of the way that systems are set up and teams work.
• 38:18
  SPEAKER_01: I once ran a survey on collaboration in Pharma, and I just said, How often do you meet in a structured way to collaborate across teams to learn about insights from markets, to learn about RD, to learn about gaps, indication possibilities, extensions, off-label use?
• 38:32
  SPEAKER_01: I think 80% of the teams that I interviewed said we don't.
• 38:35
  SPEAKER_01: We do it on a case-by-case basis.
• 38:37
  SPEAKER_01: If something hits my desk and I think it's interesting, I might go and tell Susan down the hall, but I might not.
• 38:43
  SPEAKER_01: And so I said, what would be really useful if you just had a weekly or a monthly or whatever, or even just a digital holding pot where anything that comes in that's that hit you as being interesting is shared with the rest of the company.
• 38:54
  SPEAKER_01: So people can go, that might be useful for us.
• 38:56
  SPEAKER_01: And I think there's there's a lot of potential in companies that is wasted because there's no structure to capture it.
• 39:03
  SPEAKER_01: Does that make sense to you?
• 39:04
  SPEAKER_02: Yeah, I completely agree.
• 39:06
  SPEAKER_02: There's no proactive approach, and that makes sense.
• 39:08
  SPEAKER_02: We are all busy chasing the latest developments and not necessarily planning ahead.
• 39:12
  SPEAKER_02: All right.
• 39:13
  SPEAKER_02: Last question.
• 39:14
  SPEAKER_02: We are in June 2019, and the company is Biogen.
• 39:21
  SPEAKER_02: And we are considering educanomap and whether Biogen should file educanomap for FDA approval based on a post hoc reanalysis.
• 39:31
  SPEAKER_02: After both phase three trials emerge and engage were stopped for futility.
• 39:36
  SPEAKER_02: And the question I will ask you is should they file or should they not file?
• 39:40
  SPEAKER_01: I'd say no.
• 39:41
  SPEAKER_01: I don't know anything but just the two, three, the the data that you've given me.
• 39:44
  SPEAKER_01: Based on that, I go, This sounds like really bad risk.
• 39:47
  SPEAKER_01: No.
• 39:48
  SPEAKER_01: But I don't know.
• 39:49
  SPEAKER_01: Alex.
• 39:50
  SPEAKER_03: But yes, well, it's it's June 2019, so I'm I'm slowly removing my COVID mask and saying, no, I agree with you.
• 39:56
  SPEAKER_03: But that sounds post hoc analysis when two trials have already been stopped.
• 40:01
  SPEAKER_03: That sounds like bad news to me, to be honest.
• 40:03
  SPEAKER_03: Again, caveat, don't know any of the details, but that sounds bad news.
• 40:08
  SPEAKER_02: I will hurry up and give you the answer.
• 40:10
  SPEAKER_02: That's what happened.
• 40:12
  SPEAKER_02: They actually did file.
• 40:14
  SPEAKER_02: And they get a got a very controversial approval.
• 40:18
  SPEAKER_02: Really?
• 40:19
  SPEAKER_02: But the drug was withdrawn in January 2024.
• 40:23
  SPEAKER_02: Oh, that just sounds like bad news all around.
• 40:25
  SPEAKER_01: Yeah.
• 40:26
  SPEAKER_01: But that just also feels so desperate, right?
• 40:28
  SPEAKER_01: If you're at the point where two trials fail, you put a postdoc analysis and you go, that just feels like we have nothing else.
• 40:32
  SPEAKER_01: We're gonna have to do this.
• 40:33
  SPEAKER_01: I mean, I don't as a guy, I don't know anything about it, but the having it withdrawn, yeah, it's kind of a route you don't want to go down, right?
• 40:39
  SPEAKER_01: I mean, but without knowing anything, they must have believed it's going to do something positive.
• 40:44
  SPEAKER_01: But it's surprising they got approval for it.
• 40:46
  SPEAKER_03: No, I but it's so hard.
• 40:47
  SPEAKER_03: It's so hard, but it's part of knowing when to kill things and when not to kill things is is a real skill.
• 40:53
  SPEAKER_03: And some of that is luck.
• 40:54
  SPEAKER_01: Do you remember Lily years ago?
• 40:55
  SPEAKER_01: Lily split out their R and E D team.
• 40:58
  SPEAKER_01: Do you know about this?
• 40:59
  SPEAKER_01: Uh uh no, this is news to me.
• 41:01
  SPEAKER_01: Do you want to know about this?
• 41:02
  SPEAKER_01: I'll keep I'll do my best.
• 41:04
  SPEAKER_01: So it was I took a training course in pharmaceutical medicine, and there was a conversation about, you know, developing drugs, picking picking winners, and the fact that in this kind of indication, you often end up with a huge phase three trial, loads of money lost, and you lose all the money because it's just difficult indications.
• 41:18
  SPEAKER_01: But Lily realized that one of the big problems they have is you've got your RD team doing something, and they then end up talking to the commercial team, the commercial team can't see the benefit.
• 41:27
  SPEAKER_01: And so decisions were made that weren't actually in the interest of the company because ultimately people pulling the plug didn't necessarily understand.
• 41:33
  SPEAKER_01: And so it was sort of that question of why do really, really big pharma companies struggle to innovate.
• 41:38
  SPEAKER_01: And that was the idea that maybe if we strip away the complexities and the hierarchies and the too much interference from teams that don't understand as much as the developing teams, we can sort of capitalize on the innovative energy that startups have.
• 41:52
  SPEAKER_01: And apparently they were more successful in driving trial drugs through the initial hurdles.
• 41:57
  SPEAKER_01: So I found that that interesting just thinking out how do we split things out.
• 42:00
  SPEAKER_01: But then the bit on killing things is an interesting one.
• 42:03
  SPEAKER_01: She shared this in a presentation at university, so it's not private informational.
• 42:07
  SPEAKER_01: And she said, I was brought in because, of course, either of you worked in research, which I'm guessing you both have.
• 42:13
  SPEAKER_01: You'll remember how it is, right?
• 42:14
  SPEAKER_01: You do an experiment, you think it's gonna be in science.
• 42:16
  SPEAKER_01: And I spent five years on working ice friends thinking tomorrow is gonna be the breakthrough.
• 42:20
  SPEAKER_01: And so this lady researcher said she was working with teams and she would look at their data, and people have sunk so much energies like sun costs into share buying that it's very hard to say, I am ready to let this die, because you keep thinking it's gonna keep on going.
• 42:34
  SPEAKER_01: And so I think the point you've made, that would be the biggest change maker in in industry if you could figure out what kind of cross-departmental team and skill set and personality types do you need to be able to move fast on 80% this is a go, 80% it's not a go.
• 42:51
  SPEAKER_01: That might be a team that runs in parallel, but I think if you did you could figure that out, that would change the face of Pharma.
• 42:57
  SPEAKER_03: It's one of the points I almost brought up earlier, actually, but we can maybe mention it now, is I think it's one of the difficulties in going back to silos.
• 43:04
  SPEAKER_03: Why do we have silos in Pharma?
• 43:05
  SPEAKER_03: Well, it's because we've got these huge companies that are doing a lot, and that's right, and that brings complexity, and this siloing is the reaction to that complexity.
• 43:14
  SPEAKER_03: But that exists in tension to all of the work done on what teams are effective at doing things, and it's small, well-integrated teams that are very embedded in the particular project that they're doing.
• 43:25
  SPEAKER_03: And I think, yeah, one of the problems that we have in Farmer is that those two pieces exist in parallel and in conflict.
• 43:31
  SPEAKER_03: And it's it's one of the things that is still unresolved.
• 43:33
  SPEAKER_01: Right, yeah, an observation to that on.
• 43:35
  SPEAKER_01: Yes.
• 43:36
  SPEAKER_01: So it's really like how you you framed that.
• 43:39
  SPEAKER_01: I've thought about that a lot, and I think the other pieces, of course, the silos are one thing, but also it's history, right?
• 43:45
  SPEAKER_01: If you look at it's like people working with different computer systems, somehow we always used to work with folders, and then we just moved to computer systems and we kept the folder structure and the same way of thinking.
• 43:56
  SPEAKER_01: Instead of now having a boundary, you know, a way we could easily share data without boundaries, but we still guard it and hold it in folders.
• 44:03
  SPEAKER_01: And I think it's like we haven't that cave caveman age shift we haven't made.
• 44:07
  SPEAKER_01: And if I look at pharma companies, you know, some of them have been going since the 1800s, right?
• 44:12
  SPEAKER_01: The big ones have been going for a long time, and they they existed pre-foot fax machines.
• 44:16
  SPEAKER_01: You couldn't make phone calls because that was expensive.
• 44:18
  SPEAKER_01: You couldn't actually really talk with France and Germany, Italy, and Spain as easily as we do now.
• 44:24
  SPEAKER_01: So I think we now have a lot of tools to break down silos and communicate, but the historical roots of how these structures work were laid in 18, whatever it is, and that's something that's quite entrenched and embedded in this in the construct and the contract of a company.
• 44:38
  SPEAKER_01: And that's how it's grown.
• 44:40
  SPEAKER_01: It's like a plant that grew, and now you've got to go and say, right, we're gonna trim some branches.
• 44:43
  SPEAKER_01: And that's harder.
• 44:44
  SPEAKER_01: I think it's easier if you're a biotech starting up, uh, but they don't do that either.
• 44:48
  SPEAKER_01: Where you think, okay, I'm gonna need ABCDE.
• 44:51
  SPEAKER_01: How do I build an integrated foundation now?
• 44:53
  SPEAKER_01: That's easier than going back and changing it.
• 44:55
  SPEAKER_01: So I think there's probably two sides to it.
• 44:57
  SPEAKER_02: Yeah.
• 44:58
  SPEAKER_02: Absolutely.
• 44:59
  SPEAKER_02: Isabel, this has been a wonderful conversation.
• 45:02
  SPEAKER_02: Thank you so much for joining this episode.
• 45:05
  SPEAKER_02: I feel like there's much more we could discuss.
• 45:08
  SPEAKER_02: Always.
• 45:09
  SPEAKER_02: Wh where can our listeners find more information about you or get in touch with you?
• 45:14
  SPEAKER_01: I have a YouTube channel, a LinkedIn site, and a website.
• 45:18
  SPEAKER_01: So I have a website, allowtraconsulting.com, or my LinkedIn profile, Isabel Whitama.
• 45:24
  SPEAKER_01: Excellent.
• 45:24
  SPEAKER_01: We'll include in the show notes how to reach out to you too.
• 45:29
  SPEAKER_01: I will actually share my YouTube videos 'cause they incorporate art, science and change processes, which I think are hugely fun and they're only two minutes.
• 45:37
  SPEAKER_03: Sounds like an amazing combination.
• 45:38
  SPEAKER_01: Love that.
• 45:39
  SPEAKER_01: Well, thank you so much, Isabel.
• 45:41
  SPEAKER_01: Thank you so much.