Monday, October 12, 2015

Find a Doc

In the past year or so, we've completed a significant number of assignments in clinical sciences, both in big and small companies. Demand continues to be quite high. Roles include very early-stage, translational clinical development experts to late-stage, monitoring and medical affairs profiles. I have a (rather simplistic) theory about why we’ve seen such high demand in recent years.

Back in 2008, when the bottom fell out of the overall economy, early-stage life sciences were not spared the axe. Many companies with very risky technology propositions, or with shaky or unproven management teams, were not able to find funding of any kind to advance their plans. In economic downturns, or what many like to glibly call “a correction,” the purging of entrepreneurs with less than compelling stories is often viewed as a necessary (and welcome) consequence of the belt tightening. But in 2008, even established, development-stage companies felt the impact. Companies with robust clinical plans and pipelines were suddenly finding it very difficult to raise supplemental funding to advance their nascent programs, even those that were backed by leading life sciences investors.

If you’re the CEO of a technology company, the last thing you want to do is cut R&D. So in the face of the spigot turning off, and the need to make cuts, you will be much more likely to leave R&D (relatively) intact and cut the more commercial functions. I propose that this is what happened in the wake of the economic crisis. Over the following years, the R&D engines in these companies kept chugging along albeit, perhaps, at a slightly throttled back pace. Many clinical programs that had been in early development, and in anticipation of additional support, were mothballed.

Fast forward to today. While many are currently sounding the death knell of the most recent of the biotech booms, one can’t argue that over the past few years, venture rounds and IPOs for life sciences companies have become routine, almost mundane, announcements in the trade press. Whether or not it’s the end of the run, a lot of money has flowed into the sector in the past recent years. Those mothballed projects? And the output of the R&D engines? Well somebody has to now take them into the clinic.

We’ve been seeing demand in both big companies and small. Big companies, which had made significant reductions in clinical staff during the recession, are now eager to restock the pond. Since most big pharmas are looking over their shoulders with envy at the others with advanced programs in immuno-oncology, the demand in that disease area is by far the strongest. However, since many small companies are also chasing that grail, and are drawing experienced drug developers out of big companies, it leaves pharma with a gaping talent vacuum. But big companies are far better places to learn the trade – maybe not with formal training programs, but simply being part of an organization with multiple clinical development programs, all at various stages of registration. Thus, they are more willing to take medics out of academia, without direct industry experience, but with knowledge of the process through participation as a trial site. Small companies don’t have that luxury. They need to recruit people who have already experienced the range of possibilities one sees in big companies, and who have seen some failures as well as successes.

My prediction is that the next wave will be for more commercial roles. We’re already starting to see this, but the demand for great medics is still quite high. Whether or not you think the end of the world has come in terms of life sciences funding, there’s no question that financings and public offerings have slowed. In the coming years, I expect to see a return to a more rational funding environment, and a consequent tapering of investment in clinical programs, but an increase in demand for people experienced at taking those products to market. In any case, it has been great fun being part of the latest biotech boom. Those of us with some grey hair have been through a number of these periods of financing booms and busts, so we’re girding for the ebbing that is sure to come. But while we’re in the relative boom, it’s exhilarating to be part of the building of the next generation of great companies.

Sunday, February 1, 2015

Zen and the Art of Talent

When I was in high school, all the cool kids were reading Zen and the Art of Motorcycle Maintenance, so naturally, wanting to be cool, I picked up a copy and walked around with it in my back pocket. I probably made sure the title was facing out. Also, being a motorhead, I thought maybe there would be some cool stuff about motorcycles in it to which I could relate.

When I finally started reading it, I was a bit unclear why all my classmates found it so engrossing. And not being a naturally good reader, I had to struggle through it a bit. If you’re not familiar with it, here’s a description. About halfway through, I started to understand why everyone thought it was so cool. In one theme of the book, it’s the story of a man (the author) and his son taking a cross country motorcycle trip (at times with some friends). But there’s another theme interwoven throughout, in which the topics cover various rather deep theoretical and philosophical concepts, and discussed in part with a character, Phaedrus, which we conclude is the author in a previous life, and referred to in the third person.

Look, I fully admit, I’m no genius. But I do have two cells clicking. And that was true of me in high school as well. I’m here to tell you, it was a hard book to read in ninth grade. Once I finally got through it, I came to the realization that most of my contemporaries were enthralled by the bucolic images of the motorcycle trip, but probably skimmed over most of the philosophical content. I was re-reading some of the Phaedrus sections multiple times, and was thinking I was a nudnik, until I finally had this revelation. My bet (I’ll put money on it) is that most of the kids reading that book couldn’t hold a two minute conversation with you on epistemology or emotivism without drowning.

Last week, Xconomy published an interview with Geoff Colvin, Fortune’s Senior Editor at Large, and author of Talent Is Overrated: What Really Separates World-Class Performers from Everybody Else. Using Tiger Woods as an example, Colvin argues that it’s not talent that leads people to succeed, but “deliberate practice.” He claims that Tiger Woods is successful because he “…had been better prepared than anyone in the history of the game.”


So there are no other golfers whose father gave them a club at 9 months and encouraged them to practice? Even deliberately? If he had originally been terrible/disinterested, would he have become as successful? Is the argument that with enough “deliberate practice” anyone could sing like Aretha Franklin (I’m thinking of American Idol phenom William Hung)?

The Xconomy interview made me immediately think of my experience with Zen. Candidly, Colvin’s thesis sounds to me to be a rehash of Outliers. I keep hearing people cite the 10,000 hours thing as though we could all be the world’s best at something if we just worked on it more. My guess is that they need to read the book again. In his own words, Gladwell says:

“When outliers become outliers it is not just because of their own efforts. It’s because of the contributions of lots of different people and lots of different circumstances— and that means that we, as a society, have more control about who succeeds—and how many of us succeed—than we think.”

My issue with this current cool kid trend of diminishing talent is that it can’t stand up logically. To reduce the problem to the trivial, I would argue that there is no amount of practice, 10,000 hours or otherwise, that would allow a person with one arm to compete at the Olympic level in swimming. Do we agree? If so, then it follows that a person with a severe deformity of one arm might do better, but would likely not be world-class. Still with me? So there are clearly physical limitations to being the best in the world at swimming. As Philip Zimbardo pointed out in the 1990 PBS series, Discovering Psychology, there is almost certainly something about the wiring of Greg Louganis’ brain that allowed him to dominate the sport of diving. I certainly don’t argue that some very successful people have a much more disciplined approach to practice, and that such practice (assuming it’s not reinforcing bad habits) contributes to their success. But to say that Greg Louganis or Aretha Franklin or Bill Gates or Tiger Woods didn’t have underlying innate talent is simply ridiculous.

Another problem I have with Outliers is that, again, in his own words, Gladwell compares the people to whom he refers to a cold day in August. That is an outlier. In terms of people at the top, they are just that – at the top – not outliers. In the 2012 Olympic Men’s 100m freestyle, the difference between first and eighth place was less than one second. Let that sink in a minute. Eighth place. First and third? Just a hair over a quarter of a second. These people are the top of the top, not outliers. They are all highly talented. No doubt – practice plays a major role, as does coaching, nutrition…

In my experience recruiting senior executives, I’ve come across a lot of folks who have had to work very hard to get where they are, and others who “come by it naturally.” Admittedly, the analogy between talent in business and sports can only be carried so far. But given the choice, and all other things held equal, I’d still put my money on a “natural” over someone who needs 10,000 hours of practice to be any good.

I do believe that we can all get better through practice; I just think it’s unrealistic to believe or propose that we all have it within us to be at the top of any given thing. When our kids were little, I was bemused by the parents on the soccer field who were constantly praising their kids, even when they did dumb things like kick the ball in the wrong goal. It’s endemic in today’s climate to try to convince us all that we can be the best. I’m not advocating yelling at 6 year olds for kicking the ball in the wrong goal, but whatever happened to helping them understand that they don’t want to do it too often? This is not nihilism, but realism. In fact, I’m actually quite comfortable knowing that I’ll never be the best snowboarder in the world. I wonder if Gladwell was on one of those soccer teams.

Tuesday, September 23, 2014

The Ostrich

Well, here I go complaining again. Yesterday's NY Times had an article about the proliferation of genetic tests, and how, according to Dr. Kenneth Offit, chief of clinical genetics at Memorial Sloan Kettering Cancer Center in New York, genetic testing companies are “rushing headlong into this era,” and that “individuals are getting results we’re not fully educated to counsel them on.” This got my dander up.

When my wife was pregnant with our first child, we were advised to take the AFP test. Thinking very little about it, we toddled off to one of the prenatal exams, were told that the result would indicate if our child would have Down Syndrome, and were sent home with a bit of trepidation, but having no real reason to worry excessively. After having endured the wait of almost three weeks for the test results, which was standard of care at the time, it came back "positive," and we were asked to come in for genetic counseling. We were in shock - there was no history on either side for many generations.

At the time, I was a grad student, and knew enough about genetics to be dangerous. I really didn't know much about such prenatal tests, and relied on the information provided by our doctor and the genetic counselor. After 15 or 20 minutes of listening to the counselor in a daze, I finally leaned across the table and asked, "So let me get this straight: there's no causal relationship here? These results are associative?" What I lacked in understanding of genetics, I made up for in mathematical understanding, having been a math and bio undergrad major, and having just finished a year of graduate statistics. I was furious. Had we been told that the test was not based on a scientific understanding of what AFP does, but rather a "people-who-wear-brown-shoes-live-longer" level correlative test, we would have lost a lot less sleep. It turned out that my wife gained extremely little weight during her pregnancies, and that wasn't taken into account, thus skewing the result.

So I get it. Not being appropriately counseled or informed can cause stress for the patient and family. However, I also felt and feel responsible in some measure for my own ignorance. I could have easily done more research about the test, but was guided by our healthcare professionals, and candidly, was doing so a bit blindly. Does that mean we shouldn't do AFP (or now the Triple Test) because there's some uncertainty? Absolutely not. First, times are very different now. Virtually anyone can find extremely reliable information about genetic tests and their implications in seconds, and far more easily than it would have been for me back then. Second, as a society, we learn from continually pushing the envelope. Data should not be reported to patients and their docs because we don't know everything? When will we? The paternalism is infuriating. We're now willing to withhold information, but back then we were perfectly happy giving the results of a far less robust test to pregnant couples?

The article suggests that "variants of unknown significance" should not be reported because "patients are not getting closure." Really? How much clearer can we get than "unknown significance?" These data are reported so that sophisticated healthcare practitioners can use it if they want it, but with the caveat from the reporting entity, that, based on the extant scientific literature, we don't really have any clue if it's important or not. At least Mary-Claire King concedes in the article that "most experts do not agree with her about withholding uncertain findings."

The article chooses to continue to flog the go-to whipping boy, breast cancer. The subject of the article turns out to not have genetic alterations associated with breast cancer, but rather, with stomach cancer. However, it would be impossible to advise her to take drastic actions, because the prognostic value of the test has not yet been determined. But the article also points out that "When Myriad began BRCA testing, its rate of unknown variants was 40 percent. Now it is 2 percent." So we do learn more as time goes on, right?

I remain exquisitely puzzled why tests where the analyte is DNA are somehow different from others. Is it because we collectively have the incorrect view that DNA is more deterministic than other biological substrates? Should we stop doing PSAs, too, because they don't have 100% specificity and sensitivity?

Saturday, August 17, 2013

The $35 Tuna Wrap

Wednesday night I was at one of the many events organized by MDG (MedDev Group), the area’s premier networking organization for medical device professionals. This annual event is on making the transition into the medical device industry, so naturally, the room was filled with a lot of job seekers, and those willing to help in that transition. Including me. Although I often have a tough time convincing people that I work for the client, and I’m not in the business of helping them “find their next challenge,” I do believe in supporting the community as much as possible, so I try to share my experience with both newcomers and with veterans who find themselves without a W-2.

The event included an interactive component, with the organizers encouraging attendees to stand up and tell the room what they were seeking. It was great to see that several connections were made on the spot, with one person offering what the other happened to be seeking.  As I watched, though, I was struck by how often people don’t take full advantage of opportunities like these. It may cost you $35 - $50 to attend one of these events. If all you do is stand around with a mediocre tuna wrap on a paper plate, I can make you a much better sandwich for a lot cheaper. And I’ll serve it on a real plate.

What occurred to me at that event was that even though there had been an hour of networking prior to the actual panel, the connections that were made in the interactive session hadn’t already been made. I think I must have seen about a million articles on networking by now. Everyone has their take on it; some advice is good, and some is horrible. What I DO NOT recommend is walking up to every person at a networking session and shoving a business card in their hand, or interrupting a conversation, or forcing your elevator pitch on people. It’s an art, and I appreciate that it doesn’t come naturally to some, but general politeness and common sense will always win the day. Successful networking doesn’t mean standing (or worse, sitting) along the sidelines eating your tuna wrap. It involves engaging. I wondered if those connections in the interactive session could have been made in the networking session with a better executed strategy.

Coincidentally, that same day, Katrine Bosley tweeted about a blog post from Steve Blank. He (correctly) points out that starting out by asking to have coffee to “pick your brain” is about the worst way to get someone’s attention. As a recruiter, people in transition are constantly asking to meet and want to “tell me about their objectives” and “get a sense of the market.” While I try to respond to every email and phone call, I simply don’t have time to meet everyone. More importantly, as a retained firm, we are only interested in meeting with you when we’re on an assignment for which you may be an appropriate candidate. If I meet with you today, and tomorrow get a new assignment, I’d have to interview you (as opposed to having a coffee with you) in the context of that assignment’s specification, so it really makes no sense.

Where I depart from Steve, though, is at his suggestion that you offer me something in return (and not just a nice coffee). I’m simply not that mercenary to take a meeting just because you’re going to “teach me something” or make an introduction. Indeed, I may ask you for referrals some day, but I would hope you would treat me with the same courtesy that I would treat you: if you know a potential candidate, a quick intro; if you don’t, a simple “sorry, can’t help” is fine. If those folks last night had walked up to each other and, as Steve suggests, offered something of value, would it have worked? Probably. But that’s a scattershot approach, isn’t it?

Look, there are two types of networking: trying to meet new people, and trying to get in front of a specific person. If you’re just trying to expand your network because you’re looking for a job, or raising money, or selling a product or service, then maybe “cold calls” work. Go ahead and “work the room,” but just be clear about what you are seeking, and close by asking if your new acquaintance can think of anyone who might be able to provide it, or anyone looking for it. Be polite, don’t force it, and people will respond. A follow up email to say a quick thanks is always appropriate.

If you’re targeting a specific person, that’s a different story. In that Twitter thread, Ryan McBride suggested just using the honest approach. I agree. You need to be prepared that the other person won’t accept your request, but we all know that cold calls have a limited likelihood of success anyway, don’t we? But if LinkedIn has shown us anything, it’s that we all know a lot of people who know a lot of people. Someone, someone, in your network knows the person you’re trying to reach. Work your own network first, and you’re sure to find a pathway to the person you’re seeking. Networking is an art, but that doesn’t mean sitting at a sidewalk cafĂ© with a beret sipping an espresso. There are clear tactics, and working to identify a pathway to your target is key among them.

I’ll tell you one thing that gets under my skin: when people introduce themselves to me over and over again as though we’ve never met. There are two people on “the circuit” in the Boston area who are consummate offenders. I’ve already heard the pitches, and I’ve got nothing for them. The likelihood that they’ll ever get far with me is pretty low. I’ve certainly forgotten that I’ve met a given person, so I’m happy to let one by. But after about the fifth time, I’m ready to hit someone.

So don’t be intimidated by networking events, but use some common sense. If you’d like a decent sandwich, they’re not the best places for them. You probably don’t like tuna anyway.