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.

Monday, July 29, 2013

Dogs Are From Mars, Cats Are From Venus


Vinod Khosla recently tweeted about why it’s such a good idea to have a dog. It’s cute, but it got me thinking, so here’s some free career advice.

For context, we had a dog when I was a kid, and I had one in college (possibly the stupidest thing I've ever done). Pets are kids that never grow up. They can never let themselves in and out, get a drink out of the fridge, or tell you what’s bothering them. Many people argue that they’re good because they teach kids about responsibility. What they really teach kids is that their parents are sniveling pushovers who will end up cleaning up after them and taking them to the vet. And will pay all the bills, which, these days, is about the same as sending a kid to boarding school. One winter day many years ago, as penance for me hitting the slopes with my sons, I came home to find that my wife and daughter had retaliated by buying a puppy. Some years later we ended up with a shelter cat, and then another. I was never a cat person, but my wife loves them and my daughter is a wannabe crazy cat lady. Vinod’s link above crystalized my thinking about how much we have in common with dogs and cats.

Dogs wag their tails at just about anything. They are happy to go for a ride, to go outside, to do tricks, to chase a ball, to get a bone, to go to the vet. They’re happy when they see you – EVERY time they see you. When they do something wrong, and are punished, they quickly forget. They are exceedingly loyal, even when they haven’t been treated very well. If they are in an accident and lose a limb, they don’t mope around the house lamenting the things they can no longer do, they get on with life and make do. When you leave, they wait in quiet anguish until you get home. Our dog recently had some surgery done under local anesthesia (which he wasn’t crazy about), yet later jumped out of the car, tail wagging, at the very same place to have his 8 staples removed (without anesthesia).

Being vertebrates is about the only way in which cats are like dogs. Cats don’t really care if you’re there or not; they will carry on with or without you. They show basically no emotion. They will look right at you and yawn when you return after a long separation. They’re picky about what they eat, the way in which they eat it, their grooming habits, where they lie down, where they go to the bathroom. They let you know when it’s ok to pet them, or when they will deign to sit on your lap. They approach new situations cautiously, only proceeding when they believe it to be safe. We once had a cat who would say “good morning” to you by showing you her rear end and then hissing at you.

I’ve observed, both over my operating career and as a search consultant, that the workforce is comprised of dogs and cats. Some employees are just happy to be at work, are real team players, will do what is asked of them, and only seek the occasional pat on the head. Others are gracing you with their presence, and need to be cajoled into doing things. They can be difficult to manage, requiring more than their share of attention, and can be fickle about what pushes their buttons. I confess that I was more of a dog in my operating life, and should have been a bit more catlike at times. I was too busy wagging my tail to know that I had to scratch and claw a bit more to get ahead. You’re not going to change your stripes, so it’s good to know which one you are. Reread the above two paragraphs and figure out if you’re a dog or a cat. I mean professionally. Balance is a good thing, and teams comprised of both can do very well. As an individual, you may want to balance your behavior between the two. For managers, it’s good to think of your team that way. At the very least, you’ll know if you’re going to be scratched or licked to death.



Monday, May 6, 2013

Cinco de LinkedIn

Yesterday was the 10th anniversary of the founding of LinkedIn. It’s a trending topic on Twitter, and LinkedIn founder, Reid Hoffman, about whom I’ve commented before, blogged about it as well. A while back, Luke Timmerman wrote about how the website has changed biotech and pharma, particularly through the eyes of Third Rock Partner, Mark Levin. It has been very interesting for me to watch the growth and development of the site, particularly after I started in the search biz. I was tempted to comment on Luke’s excellent piece, but now I’m glad I waited.

When noobs ask me about LinkedIn, I tell them it’s Facebook for professionals. They get that immediately, but it often still requires some explanation about why it’s a good idea to join. Many people comment on how great LinkedIn is, and how it has changed recruiting. Couldn’t agree more. It’s a fantastic site, and a great tool, which we fully embrace. However (did you think there wasn’t going to be a “but”?), I view it as just that – a tool. It’s not a replacement for executive search. I’ve been deferential about this point in the past, but I’m going to be very clear here. If you’re relying on LinkedIn to fill your senior executive roles, you’re making a big mistake. Even Mark Levin, who admits to being obsessive about LinkedIn, and about whom Luke wrote that “…LinkedIn temporarily shut down his account, until he called the company and assured them he’s a real person using the site for business.”, said “We don’t know everybody.”

I readily admit: neither do we. I personally know a lot of people in the industry, and there are thousands of others in our database, but come on – there are over a billion people on Facebook and let’s call it 200 million on LinkedIn. NOBODY can claim to even come close to having that kind of database. And that’s why it’s a great tool for us. It helps us identify potential candidates. But remember: 1) the only profiles on LinkedIn are those that are put on there by the member him/herself, 2) no networking site will have the kind of detailed knowledge that a recruiting firm will have on many individuals – full resumes, interview notes, references from prior searches, etc., and 3) The most senior executives don’t typically understand the value of maintaining (and it does require maintenance) a LinkedIn profile, or don’t have the time. These are the folks to whom I have to explain what “Facebook for professionals” means. They typically either don't have profiles, or if they do, they aren't up to date.

Mark admits to spending half an hour a day trolling for connections on LinkedIn because “Our biggest challenge is to find great people.” I would argue that it’s not a good use of his time. A random walk through 200 million people, even with LinkedIn’s suggested connections, is a bit less focused than our approach. Additionally, we utilize additional resources to identify “passive” candidates – folks who intentionally maintain a low profile, and don’t realize that the opportunity I want to present to them is their next great move. I guess if your outlook is “well, I’ll look in this one pool of active candidates and be happy with whatever I find,” then LinkedIn is your answer. And don’t bother calling me, because you won’t appreciate the value of our high touch, exhaustive approach. If, however, you want to scour the market and find the best fit for the position, retained executive search is your answer. We certainly won’t be the right solution for everyone, but I’ll be the first to tell you if we’re not.

One last point. I’m a founding board member of The Bioscience Network. A service provider myself, I championed the idea of limiting the number of service providers allowed to attend our events, and to charge them more than industry professionals. I get it. Nobody wants to go to an event and be overrun with service providers trying to shove business cards in your hand. Now look at the stats from the LinkedIn Q1 13 earnings report. More than half (57%) of the company’s revenue comes from people like me. That may not translate directly to membership, but the site’s membership clearly includes tons of executive recruiters, talent acquisition folks, HR staff, contingency recruiters, etc., so don’t get fooled by total membership numbers. I admit this may be a minor correction to the total. The real issue is network. And the network of a decent recruiting house delivers way more bang for the buck. We have access to LinkedIn, too, so you’re getting the value of that pool of candidates, plus ours, many of whom you simply won’t find on your own.

Sorry for this infomercial, but I’m kinda tired of hearing people say that they can do what we do using LinkedIn. It’s a great site and a great tool, but you just can’t use it as a substitute for a focused search. Would you use LegalZoom to incorporate your life sciences startup?

Tuesday, April 30, 2013

Beaten to the Punch



Last week, Luke Timmerman’s interview with Noubar Afeyan was published, and I had some immediate comments, but was tied up at BIO (as was Luke). How discourteous of Luke to write a story when everyone was at the meeting! I thought to myself: I’ll write a blog about that when I get home. Well, Katrine Bosley beat me to the punch, with many of the same thoughts I had. If you didn’t read the original article, I’ll recap.

Noubar made the argument that biotech could be much more orderly if people would just go to pharma, see what they needed, and develop those products. He made the analogy to the auto industry, which has an orderly supply chain. Using the example of brake pads, he points out that no supplier would spend years developing a novel brake pad, and proposing to sell it to auto manufacturers at thousands of dollars per year to balance the losses incurred in the development of the new pad. That’s essentially what biotech (and pharma, for that matter) do. The production cost for a $10K/yr therapeutic is orders of magnitude less than that, but the end user price includes the cost of development, since most of the products in the pipelines of biotechs and pharmacos fail.

In her article, Katrine argues that i) there is a wide spectrum of what constitutes a biotech company, so Noubar’s argument may not apply, and ii) it encourages “teaching to the test.” That is, developing products that are of interest to pharma solely because they fit a box that the pharma is trying to fill.

Katrine disclaims that she’s known Noubar for a long time, and that he was an investor in her prior companies. I’m in the same boat, having had Noubar as a client in his PerSeptive days, and I concur with her that he sees a longer horizon than most. In this case however, I couldn’t agree with Katrine more. I’ll cite two examples to support her argument.

In grad school, we were quaintly known as “the rat lab,” being the only animal facility in the department. When the lab manager left, a new person was hired who promised to bring some order into the lab. With a military background, he set schedules, developed reagent supply/replenishment programs, etc. The lab was certainly much more organized, but in addition to the operational structure he provided, he tried to set timelines for completion of experiments without providing for the inevitable detours or unexpected results. He lasted a few months. What he failed to realize was that you can’t mandate innovation by putting it on a Gantt chart.

Years later at Athena Diagnostics, I established monthly update meetings for all the senior managers. I had gotten wind that people thought I wasn’t doing anything in Business Development. Importantly, I reviewed all the projects – most importantly, the ones that I had passed on. They failed to realize that running BD means saying “no” a lot. There were tons of things I’d look at that just didn’t make sense. They would say “Why don’t you bring us a decent diagnostic test for Alzheimer’s?” My response? Well, since we don’t have our own discovery effort at the company, and since nobody has developed a decent test (there still isn’t one 15 years later), what would you like me to do? Sometimes, you can’t mandate BD either.

If a car manufacturer goes to a supplier and says “we need a brake pad that will fit into this caliper, and that can sustain temperatures of 800°,” the suppliers toddle off and try to develop one. Yes, sometimes that requires innovation, but there’s almost always an engineering solution or workaround to mechanical problems. Mother Nature isn’t nearly as accommodating.

Tuesday, April 16, 2013

Supremely Irritating



This blog has been pretty dull lately, but as I’ve said before, I try to keep my mouth shut if I have nothing to say. This one has me pretty riled up.

The Supreme Court heard arguments yesterday on the patentability of genes.  There is a sense of jubilation coming from the academic camp, as evidenced by Eric Lander’s and Bob Cook-Deegan’s high five following the hearing. I’m not convinced that their jubilation is justified. If you’re having trouble sleeping, you can read the whole transcript, but from my reading, the Court didn’t sound like it’s ready to clamp down on gene patents.

What got me really riled up was, in the aftermath of the events at the Boston Marathon, on the advice of a tweet, I turned to PBS to watch what was promised to be unvarnished coverage. I happened on a piece about the SCOTUS hearings on gene patents. On the “academic” side of the argument was Ellen Matloff, a genetic counselor at Yale. She, characteristically of many academics, completely confused the issue, bringing arguments about the reduced cost of whole genome sequencing, insurance companies denying reimbursement, etc. None of which have anything to do with what’s at issue.

She claims that “Myriad invented nothing.” Really? Through linkage analysis, the BRCA1 gene was localized to one arm of one chromosome by the team led by Mary-Claire King, announced at an ASHG meeting in 1990. Four years later, the gene’s sequence was identified by, in part, Myriad scientists. Turning it into a commercially reliable clinical diagnostic test was done by one company: Myriad.

She also claims that Yale had been conducting diagnostic testing, which was subsequently shut down by Myriad. Correct. That’s how patents work. But it’s independent of whether or not the gene itself can be patented. What she’s really complaining about is that she can’t perform the testing in her lab (read: can’t make money from offering the test). That’s what gets under the skin of most academics. I’m not aware that Myriad, or any other patent holder, prevents others from doing true, basic, academic research. It’s not in their interest to do so. Think of it this way: a company discovers a bunch of mutations responsible for a disease. An unrelated researcher identifies a new mutation. Would they propose not licensing that mutation to the dominant provider and offering testing for that single mutation? How does that benefit anyone – the company, the researcher, or most importantly, patients?

I’m not a lawyer, and certainly not qualified to argue before the Supreme Court, but it all seems pretty simple to me. If you identify a method to diagnose a patient with a disease, assuming that it’s scientifically and clinically justified, it is novel, non-obvious, and reduced to practice, and therefore, should be patentable. Why does it matter if the method uses DNA as the substrate as opposed to, say, serum?

Nobody is patenting a person’s DNA. Never have; never will. Nobody with any knowledge of the matter believes that such a thing would be patentable. However, utilizing the chemical nature of something found in nature to identify a person with a disease meets the criteria of patent eligibility. What’s so difficult about that?