Wednesday, November 10, 2010

Health Advances Advances

I was privileged to be invited to the Health Advances panel last night on “Patient-Driven Healthcare: New Commercialization Strategies” at the Mandarin in Boston. As always, Mark, Skip and the crew put on a great event in a spectacular venue. The networking over wine and aps was so engaging that it was difficult to get people in the ballroom to hear
discuss this timely and important topic. They finally managed to herd us into our seats, and Skip Irving led a lively panel discussion.

There has been a lot of gum flapping about personalization for many years, but not a lot of solid progress. Yes, I’m aware of Herceptin et al., but Dx/Tx combos are still quite uncommon. I was initially a bit skeptical that this would be more of the same gum flapping, but was most intrigued by the part of the title after the colon: “New Commercialization Strategies.” The discussion thankfully turned out to have less to do with personalization, as the topic is commonly beaten to death, and more about the role of the patient in future healthcare.

In his opening comments, Jamie noted that Skip’s choice of words (“…patients at the table for these discussions”) reflected a misplaced focus, and should be turned around (“…patients allowing others at the table for these discussions”). I could hardly bite my tongue and wait for the Q & A.

I never did get the chance – the discussion ran significantly over, but everyone was enjoying it. Here’s my problem: with all due respect, I think Jamie is wrong.

I am reminded about a talk at an American Neurological Association meeting many years ago. In 1997, Allen Roses (who, by the way, completely disagrees with my prior snide comment about personalization) left Duke after leading the team that discovered the ApoE alterations associated with Alzheimer’s Disease to become SVP of Genetics Research and Pharmacogenetics at GlaxoSmithKline (where he remained until 2008 when he returned to Duke). Shortly after the announcement, he was giving a keynote lecture at the ANA meeting and started off by, well, not exactly ‘warming up’ the audience. Through a bit of a snarl and with a wagging finger, his opening lines went something like this: “I was stopped in the hall on the way here and a former ‘colleague’ asked me how it feels to be a whore, apparently referring to my recent move from an academic position to the crass, commercial GSK. Well let me tell you something. I am not a whore. Drug companies make drugs. Doctors don’t make drugs.”

I think Allen hit the nail on the head (although I may have said it a bit more politely). No party to this effort can take another for granted, but frankly, patients don’t make drugs, either. Yes, they have sometimes been seen as a tool to serve the purposes of a drug company in their commercial efforts, but there are also plenty of examples of true collaborations between a patient group and a drug company that served the needs of both parties. And yes, the patient groups are, will continue to be, and rightly should be an important part of the equation, but let’s not underestimate the need for a commercial partner in bringing a product to market.

Having said that, a system that delivers a product to the market only after investing $1B and 15 years of effort cannot sustain itself much longer. And what I was a bit disappointed about last night was that nobody cared to opine on that part after the colon. What are the new commercialization strategies? I have my own ideas, and have blogged about them before, but I would have really liked to have heard from the panel about their vision for the future of the drug development paradigm. Particularly on the heels of Fred Frank’s comment yesterday proclaiming the end of big biotech (I think he’s wrong, too).

The best comment of the evening? I’m not sure if everyone caught it, but Al made the provocative suggestion that we may soon see an outcomes-based reimbursement system. Could you imagine going to your healthcare providers and telling them that you’re only going to pay them if you get better?

Patient-driven healthcare is a good thing  …to a point. Years ago when I was at Athena Diagnostics, I led the team that launched the first test for neutralizing antibodies to β-IFN. At the time, the interferon therapies (Betaseron® and Avonex®) were the only options for patients with MS, and both were very expensive. Our assay identified patients in whom the neutralizing antibody titer was high enough that they were no longer deriving the benefit of the therapy (arguably the first personalized medicine test).

It was like selling ice cubes to Eskimos.

Athena Sales Rep: “Doc – use this test to see if your MS patients are responding to the drug.”

Neurologist: “Lemme get this straight. You think a patient with MS will allow me to stop the only hope they have for relief of their symptoms? Don’t let the door hit you on your way out.”

Now once the interferon alternative, Copaxone®, came on the market, it was a different story. But prior to that, no doctor would have stopped the therapy, no matter what the antibody titer. That would have been the correct decision, but it would never have been tolerated by patients.

All in all, a great event. It’s always better when there’s something to talk about. And that’s coming from someone who really knows how to flap gums.

Thursday, November 4, 2010

Nice Guys Finish Better

This morning’s peHUB Wire has a great article on Reid Hoffman at Greylock. (ok, so I paraphrased this blog’s title from the cover story in VCJ. Sorry.) I don’t know this guy, but I like him already. Look, I get it. We’re all busy. But does that mean we can’t take the time to be civil and to help others out? It sounds like Reid and I share a fault: we may err on the side of being completely unable to say “no” (I once got called into Peter Feinstein’s office back at Feinstein Partners where he told me that I was the “biggest sap” in the office because I couldn’t say “no”). It’s funny – as a recruiter, lots of people don’t have any time for you …until they’re looking for a job. Then they’re all too eager to “meet to explore my next steps.” So here are some of my gripes and suggestions. In no particular order.

  • If you tell someone you’ll get back to them “early next week,” get back to them early next week. And here’s how that works: “Early next week” is from 8:00 Monday morning until noon on Tuesday. “The middle of next week” is from noon on Tuesday until noon on Thursday. “The end of next week” is from noon Thursday until 6:00 on Friday. Even if all you can do is drop a line that says “I got tied up and now won’t be able to get to this until Thursday,” take the 6 seconds to do it. You’ll be happy you did.
  • How long does it take to hit the reply button on an email? And yes, I get it. We all get ten thousand emails a day. But have the common courtesy to respond, even if it’s to say no. You can still do so politely, and we’re all adults and can be told no, but it’s annoying and unprofessional to be left hanging. As a recruiter, I take the time to call back candidates who were in the final running but were not selected. I can’t tell you how many times people thank me for taking the time to do so, since most in this business don’t. More importantly, it’s a reflection on my client. At the senior level, my client is likely to run into these same people again in a business transaction, and it wouldn’t be good to leave them with a bad taste in their mouths about the client.
  • Is it really going to kill you to spend half an hour with someone who is willing to come to your office? Of course, there are cases when you are particularly happy with a service provider or other vendor, but are you really saying that it is not possible that another service could be better or provide something that you’re not currently getting? Frankly, I have to turn down lots of requests from candidates who want to meet to discuss their career plans, because I simply don’t have the time to meet everyone, and the meeting is only relevant when we are on an appropriate assignment. When one does come along, I’d do the interview all over again anyway, so it’s generally not a fruitful use of time. However, if I have the bandwidth, I’m usually willing to grab a quick coffee with someone.
  • Say “thank you” every now and then. I am constantly amazed when you do a big favor for someone or a company and it’s not even acknowledged. It’s not that I’m fishing for compliments, it’s just 1) nice to hear it and 2) what I would do were the tables turned. Take that extra 30 seconds to pop off a quick email to say thanks to someone. They’ll remember it.
  • Respect others’ time. I, like Reid, would be happy to meet you on a weekend or evening. But remember that you’re taking time away from my family and down time, so don’t overstay your welcome.
It is possible to have balance, get things done, and be a “nice guy.” Reid has obviously done it, and I bet he and I are not the only ones (that is, assuming you think I'm a nice guy...).

Shameless plug: Come join us for a great panel discussion with George Church, Kevin Davies and Phil Reilly on the revolution in whole genome sequencing on 12/9. Register here.