One of the things that has struck me about life science researchers, entrepreneurs, teachers and students is the sense of mission — compared to other technology entrepreneurs, it’s not just about the money.
The story of John Crowley (as immortalized by the movie “Extraordinary Measures”) and others fighting to solve rare childhood diseases are particularly good examples of this. (Some of their pricing decisions are controversial, but that’s another issue).
But no industry or line of work is full of saints (not even, alas, the Catholic church). Every industry has its bad apples.
This week Fortune tells the story of four executives of Synthes who plead (in effect) no contest over deaths due to an untested medical implant called Norian. The short version is that Norian is a calcium glue that works well for (and was approved for) arm and skull breaks — because gradually over time it transforms itself into bone.
However, Synthes wanted to go after the larger spine fracture market. The execs used a variety of marketing techniques to try it on humans while bypassing GRAS or FDA qualification procedures (as an off-label treatment).
The problem is that when used with spines, in some cases the glue got into the bloodstream, caused blood clots and killed people almost immediately. And, in fact, this showed up pretty quickly in animal tests. Several employees raised alarms, but top management went ahead anyway.
As intended by the magazine, the story is chilling. We expect this sort of behavior out of tobacco companies (or, once upon a time, out of polluting factories) but not out of FDA-regulated companies selling life-saving products.
I don’t get how this happened, but then I’ve never worked in an organization with a culture as toxic as this one appears to have been. It can’t just be about the money. At some point, perhaps there was the escalation of commitment — the cover-up or fear of getting caught — but surely someone early on thought “we can’t do this” or “it’s not worth the risk” (whether to the patients, companies or the individual employees).
Perhaps it’s just mirroring a broader decline in society’s moral compass (or maybe just a more effective process of rooting out fraud that has always existed at some level). Even so, as an educator we all wonder what we can or should do to prevent, inoculate against or early identify such attitudes and behaviors.
Tuesday, October 2, 2012
Wednesday, May 23, 2012
The importance of teamwork
One of the major reasons for the existence of KGI is to span the gap between the academic and corporate views of life science research. We all tend to focus on the nature of the output, i.e. basic vs. applied science. However, as our students discover during their yearlong projects with companies, the way work gets done is also very different.
One area of potential culture clash is the real world importance of teamwork, as highlighted by an article earlier this month in Nature Bioentrepreneur. A few excerpts:
One area of potential culture clash is the real world importance of teamwork, as highlighted by an article earlier this month in Nature Bioentrepreneur. A few excerpts:
From academic solos to industrial symphoniesI am going to recommend this reading for our entering students, particularly those in our PPM program (the world’s first post-PhD master’s program) who have chosen to leave the world of academic science in hopes of finding a corporate position. A graduate professional education is as much about developing norms and expectations as it is imparting specific technical or business knowledge.
Gwen Acton, Alicia Gómez-Yafal & Emily WalshPublished online: 17 May 2012
Academic researchers often need to stand out to advance, but the corporate world calls for team players. Moving from one world to the other can be a culture shock.
...
Individual project ownership is often encouraged and rewarded in academia, yet this approach in industry downplays the contributions of the team and inhibits key communication required for the success of highly multidisciplinary drug development projects. ... Over the years, we have seen many scientists undermine their careers by trying to do too much on their own.
...
Individual project ownership, and the recognition that follows, is the pillar on which careers are made or lost in the academic arena. ... Competition is indeed the name of the game in academia, and it is arguably not a bad thing. In industry, on the other hand, rapid, nonlinear career evolution is business as usual. Competition is reserved for external parties and has no place within your team. Development of the product, which will bring benefit to the patient, is central. Individual contributions routinely take a peripheral place, and any meritocracy is team based, because drug discovery projects are among the most multidisciplinary projects of all scientific endeavors.
Going solo in this atmosphere is at best a kamikaze approach and definitely career limiting, in our experience. ... Scientists who are not team players are often passed over for roles in startup biopharmaceutical companies. This is because industrial R&D is as much a team- and people-oriented effort as one that relies on an individual with particular expertise. As one venture capitalist (VC) puts it, when selecting startup management, “choose attitude over aptitude”. These views are likely shocking for scientists in academia, but they are widely held in industry.
Wednesday, May 2, 2012
Capstone professional education
Today is the biggest day of the year here at KGI, as 88 graduate students present the results of their year-long Team Masters Project. The TMP is the capstone of the KGI experience, allowing teams of 4-5 students to work to meet the needs of a real company.
Realism is the watchword of the TMP program (and KGI more generally). The students work as consultants (with the faculty advisor as the senior partner) to identify and address the needs articulated by their industry liaison. This is not about getting a grade: this is about delivering results that satisfy the promises the team made to their sponsor. Unlike (most) projects in the real world, the deadline is completely immovable, as our students are all planning on graduating and leaving KGI next week.
There are analogous programs in some professional schools, such as the business school context where I worked for 11 years. However, such efforts are usually a single semester and a single course (KGI students treat their TMP as a double class).
This is my second TMP Day, but my first as a KGI faculty member. It’s also a record year for the TMP program, with 19 projects and (for the first time) being presented in parallel sessions. Of the 19 projects, 11 are from returning sponsors — eight of these sponsoring in consecutive years.
I watched three projects during the lead off segment. All three played to KGI strengths: two related to rare diseases and a third to genomic medicine.
For Pfizer, the team compared the regulatory approval processes for orphan and non-orphan drugs that were approved over a ten year period. After examining regulatory disclosures for 95 drugs to treat conditions of hematology, pulmonology, endocrinology, neurology, they found that the orphan drug trials had fewer trials and number of trial participants — but the time required for clinical trial and regulatory approval were similar. The study is expected to be published in the Clinical Pharmacology and Therapeutics Journal.
For Sigma-Tau, the student team examined the direct, indirect and intangible costs for a rare childhood disease, totaling over the direct costs were over $5 billion. After adding up medical and other quantifiable costs, they used social media to contact parents of patients to better understand the impact of the disease on these children and their families.
The project for Express Scripts/Medco considered how (or whether) this pharmacy benefits manager should leverage the opportunities to create new business around whole genome sequencing. Considering both the feasibility and attractiveness of these opportunities, they evaluated three ways of generating revenue from customers — in oncology, pharmacogenomics and preventative care — as well as business models based on selling the data for other purposes (such as pharma research).
This year I’ve been advisor for two projects from beginning to end (the first faculty member to do that).
The first team to present analyzed the feasibility of building an open pond algae farm for the 18,000 acres of Florida land owned by Clear Springs Land Company. The biofuels industry is a potentially huge market, but this requires hundreds of millions of investment in unproven technology to compete with commodity oil prices. After reviewing the literature, talking to experts, working with a specific technology provider and attending an algae conference, my team concluded that it would be possible to get a positive NPV (over 10 years) by selling biodiesel and aquafeed from the algae cultivation.
This afternoon will bring my second team, who have compared R&D processes in four Fortune 500 companies and a large government lab. From 73 interviews, they created a six-step model of the innovation journey: opportunity recognition, idea generation, idea crystallization, consensus building, management approval and implementation. This project was a rare one in that it was sponsored by Eli Lilly, but the full findings are being shared with participating companies and members of the Industrial Research Institute. (They also expect to publish a summary in Research-Technology Management, the IRI journal).
Other sponsors this year included Abbott Medical Optics, Amylin, BioMarin, City of Hope, Gilead, Life Technologies, Monsanto and Tecan.
Once the final reports are submitted next week, the students are done. But for the sponsors, TMP director and (soon) faculty advisors, the process for next year is just beginning again.
Realism is the watchword of the TMP program (and KGI more generally). The students work as consultants (with the faculty advisor as the senior partner) to identify and address the needs articulated by their industry liaison. This is not about getting a grade: this is about delivering results that satisfy the promises the team made to their sponsor. Unlike (most) projects in the real world, the deadline is completely immovable, as our students are all planning on graduating and leaving KGI next week.
There are analogous programs in some professional schools, such as the business school context where I worked for 11 years. However, such efforts are usually a single semester and a single course (KGI students treat their TMP as a double class).
This is my second TMP Day, but my first as a KGI faculty member. It’s also a record year for the TMP program, with 19 projects and (for the first time) being presented in parallel sessions. Of the 19 projects, 11 are from returning sponsors — eight of these sponsoring in consecutive years.
I watched three projects during the lead off segment. All three played to KGI strengths: two related to rare diseases and a third to genomic medicine.
For Pfizer, the team compared the regulatory approval processes for orphan and non-orphan drugs that were approved over a ten year period. After examining regulatory disclosures for 95 drugs to treat conditions of hematology, pulmonology, endocrinology, neurology, they found that the orphan drug trials had fewer trials and number of trial participants — but the time required for clinical trial and regulatory approval were similar. The study is expected to be published in the Clinical Pharmacology and Therapeutics Journal.
For Sigma-Tau, the student team examined the direct, indirect and intangible costs for a rare childhood disease, totaling over the direct costs were over $5 billion. After adding up medical and other quantifiable costs, they used social media to contact parents of patients to better understand the impact of the disease on these children and their families.
The project for Express Scripts/Medco considered how (or whether) this pharmacy benefits manager should leverage the opportunities to create new business around whole genome sequencing. Considering both the feasibility and attractiveness of these opportunities, they evaluated three ways of generating revenue from customers — in oncology, pharmacogenomics and preventative care — as well as business models based on selling the data for other purposes (such as pharma research).
This year I’ve been advisor for two projects from beginning to end (the first faculty member to do that).
Presentation by Clear Springs project team |
This afternoon will bring my second team, who have compared R&D processes in four Fortune 500 companies and a large government lab. From 73 interviews, they created a six-step model of the innovation journey: opportunity recognition, idea generation, idea crystallization, consensus building, management approval and implementation. This project was a rare one in that it was sponsored by Eli Lilly, but the full findings are being shared with participating companies and members of the Industrial Research Institute. (They also expect to publish a summary in Research-Technology Management, the IRI journal).
Other sponsors this year included Abbott Medical Optics, Amylin, BioMarin, City of Hope, Gilead, Life Technologies, Monsanto and Tecan.
Once the final reports are submitted next week, the students are done. But for the sponsors, TMP director and (soon) faculty advisors, the process for next year is just beginning again.
Tuesday, April 17, 2012
Practical uses for DNA sequencing
Although we at KGI focus on genomic sequencing as an antecedent to the Brave New World of genomic medicine, in the mass market it’s probably best known for “Finding Your Roots.” However, the LA Times (and the Boston Globe before it) report on a much more direct impact on the average consumer: fish fraud.
As the Times reports
This does seem like technology will allow us to solve a problem of economic fraud — minor as it may be.
As the Times reports
Tests on seafood sold at Los Angeles sushi bars, restaurants and grocery stores have revealed that more than half is not labeled correctly, [Oceana] a nonprofit organization is reporting today.As someone who loves sushi and seafood more broadly, this is distressing. Sea bass is perhaps my favorite fish entrees, while I usually have yellowtail and other tuna when I eat sashimi.
…
The U.S. Food and Drug Administration prohibits so-called species substitution. Still, the practice remains prevalent. Consumer Reports found that 18% of seafood samples its researchers collected from retail stores and restaurants on the East Coast last year was mislabeled. A 2011 investigation by the Boston Globe reported that 48% of the fish it collected from Boston restaurants, grocery stores and seafood markets was sold with the wrong species name.
FDA spokesman Douglas Karas said the agency is working to determine how often, or at what point in the supply chain, fish substitution occurs. Most of the seafood fraud complaints the FDA receives come from consumers at the retail level, Karas said. The FDA is conducting a yearlong DNA test of about 800 fish collected across the nation.
…
In the L.A. samples, red snapper was misidentified 100% of the time, DNA tests showed. Tilapia and pollock were popular substitutes, the report said. Dover sole was discovered to be Asian “sutchi catfish” or common sole, and white tuna was often actually escolar, a snake mackerel with known diarrheal effects. The fish has been banned in some countries.
Sushi restaurants had the highest incidence of mislabeling in L.A., the study found. Oceana reported that 87% of the samples of 10 types of fish it took from 21 sushi eateries were not correctly identified.
All of the red snapper sushi sampled was mislabeled. Half of it was tilapia. Eighty-nine percent of the white tuna sampled at sushi restaurants turned out to be escolar.
Samples of yellowtail sold at sushi restaurants were often Japanese amberjack. Flounder was frequently sold as halibut, and sea bream was substituted for sea bass.
This does seem like technology will allow us to solve a problem of economic fraud — minor as it may be.
Thursday, March 22, 2012
Biotech business reading list
On behalf of my employer, today I did an online recruiting seminar for KGI — aimed at prospective master’s students who have an undergraduate science background and were interested in our business programs. On one slide, I list the various industries we serve — biotech, pharma, medical devices, diagnostics — as well as a few areas beyond human health, like biofuels.
One student asked about learning more about life science industries. As an economic historian, I’m big on business histories, so I said I would recommend some books. (A half dozen of the participants asked for my list.)
When the webinar was over, I went to my office bookshelves and looked at what was there. It turns out they’re all about the biotech industry. I also went down the hall to visit our resident expert on biotech industry history, Steve Casper, to see what he had that I don’t. Together I came up with a list of seven books — most of which assume little or no prior knowledge of the industry or its science.
One book stands alone: From Alchemy to IPO. The first book about the business of biotech, it summarizes the key developments in the 20th century biotech industry, including histories of Genentech, Amgen, Genzyme and the Human Genome Project. Yes, it’s now more than a decade old, but nothing provides such a complete picture of the industry for those without any prior understanding.
Another book — Science Business — offers what may be the definitive view of the economics of the biotech industry. Harvard Business School professor Gary Pisano tries to explain why biotech is so hard, and thus why most biotech companies can’t make money. (It’s the most advanced of the books and thus probably not the best choice for someone without a business background).
Two books are about Amgen, the SoCal biotech company with closest ties to KGI (they’ve hired 1/6th of our graduates). The Amgen Story is a coffee table book and authorized history of the company’s first 25 years. Perhaps a more useful source is Science Lessons, the memoir by Gordon Binder of his years (1988-2000) as Amgen CEO.
Surprisingly, only one book has been written (so far)about Genentech, the company that converted the Cohen-Boyer patent into a new industry. The newest book on the list, Genentech: The Beginnings of Biotech documents Genentech during the 1970s and 1980s, based on UC Berkeley’s unprecedented archive of interviews with early California biotech pioneers.
Steve had two books that I didn’t. One is The Billion Dollar Molecule, a story of the successful efforts by Vertex to develop therapies for AIDS and hepatitis C. (I guess this is biotech’s version of The Soul of a New Machine, sans Pulitzer).
The one he highly recommended is Invisible Frontiers, an early book that documents the race between Harvard, UCSF and Genentech to clone the gene that would allow synthesis of human insulin.
The only one I’ve read so far is From Alchemy to IPO. I won’t be able to make a dent in the list this semester, but I’m going to take some for my long trips this summer.
References
One student asked about learning more about life science industries. As an economic historian, I’m big on business histories, so I said I would recommend some books. (A half dozen of the participants asked for my list.)
When the webinar was over, I went to my office bookshelves and looked at what was there. It turns out they’re all about the biotech industry. I also went down the hall to visit our resident expert on biotech industry history, Steve Casper, to see what he had that I don’t. Together I came up with a list of seven books — most of which assume little or no prior knowledge of the industry or its science.
One book stands alone: From Alchemy to IPO. The first book about the business of biotech, it summarizes the key developments in the 20th century biotech industry, including histories of Genentech, Amgen, Genzyme and the Human Genome Project. Yes, it’s now more than a decade old, but nothing provides such a complete picture of the industry for those without any prior understanding.
Another book — Science Business — offers what may be the definitive view of the economics of the biotech industry. Harvard Business School professor Gary Pisano tries to explain why biotech is so hard, and thus why most biotech companies can’t make money. (It’s the most advanced of the books and thus probably not the best choice for someone without a business background).
Two books are about Amgen, the SoCal biotech company with closest ties to KGI (they’ve hired 1/6th of our graduates). The Amgen Story is a coffee table book and authorized history of the company’s first 25 years. Perhaps a more useful source is Science Lessons, the memoir by Gordon Binder of his years (1988-2000) as Amgen CEO.
Surprisingly, only one book has been written (so far)about Genentech, the company that converted the Cohen-Boyer patent into a new industry. The newest book on the list, Genentech: The Beginnings of Biotech documents Genentech during the 1970s and 1980s, based on UC Berkeley’s unprecedented archive of interviews with early California biotech pioneers.
Steve had two books that I didn’t. One is The Billion Dollar Molecule, a story of the successful efforts by Vertex to develop therapies for AIDS and hepatitis C. (I guess this is biotech’s version of The Soul of a New Machine, sans Pulitzer).
The one he highly recommended is Invisible Frontiers, an early book that documents the race between Harvard, UCSF and Genentech to clone the gene that would allow synthesis of human insulin.
The only one I’ve read so far is From Alchemy to IPO. I won’t be able to make a dent in the list this semester, but I’m going to take some for my long trips this summer.
References
- Cynthia Robbins-Roth, From Alchemy to IPO: The Business of Biotechnology, Cambridge, Mass.: Perseus, 2000.
- Gary P. Pisano, Science Business: The Promise, the Reality, and the Future of Biotech, Boston: Harvard Business School Press, 2006.
- David Ewing Duncan, The Amgen Story: 25 Years of Visionary Science and Powerful Medicine, San Diego: Tehabi Books, 2005.
- Gordon Binder and Philip Bashe, Science Lessons: What the Business of Biotech Taught Me About Management, Boston: Harvard Business Press, 2008.
- Sally Smith Hughes, Genentech: The Beginnings of Biotech, Chicago : University of Chicago Press, 2011.
- Barry Werth, The Billion Dollar Molecule: One Company's Quest for the Perfect Drug, New York: Simon & Schuster, 1994.
- Stephen S. Hall, Invisible Frontiers: The Race to Synthesize a Human Gene, Redmond, Wash.: Microsoft Press, 1988 (originally published in 1987 by Atlantic Monthly Press, and also published in 1996 by Genentech and most recently in 2002 by Oxford).
Friday, March 16, 2012
John, Paul and Eroom
Catching up on “In the Pipeline” over spring break, I followed Derek Lowe’s pointer to yet another article in Nature Drug Discovery attempting to explain the declining productivity of drug R&D.
Rather than start from scratch, the team from Sanford C. Bernstein (an investment research company) summarize many of the previous diagnoses, noting the lack of incommensurability of the earlier proscriptions:
The main point of the article is to introduce a so-called “Eroom’s Law”, in which the number of new FDA-approved therapies (per $ million R&D) fell by half every nine years. It is intended to be the inverse of the Moore’s Law that has driven IT improvements or more than 40 years, in which the number of transistors per chip doubles every two years.
The Eroom’s Law was the major new gimmick of the Scannell et al article, and Lowe devoted an entire posting to it. I’m far from convinced: unlike Gordon Moore, there’s no real explanation of the causal mechanisms — even post hoc. Instead, it seems more like Eroom’s Syndrome — a collection of symptoms with multiple root causes.
The four (possibly five) causes that the authors identified:
Some of these are dog-bites-man stories. The excess of caution by the FDA is like the weather — everyone complains about it but nobody does anything about it. Even though they mostly dismiss it, the “low-hanging fruit” argument is also an old one.
Interestingly, they argue that “throw money” is easily reversed: if, in effect, big pharma R&D shops had become fat, dumb and happy (my term not theirs), a prescription of lean and mean can be applied with little impact on output. If true, this would certainly help reverse the trend.
It’s the two remaining ideas that to me seemed the novel ones.
Better than the Beatles
This was I thought the most clever argument — both in its identification, and in its framing:
They point to a specific area — anti-ulcerants — as an example where drug discovery is held back by the back catalog. Two families of (now generic) solutions are already available, and while the third approach “would probably be safe and effective,” it is unlikely that any healthcare reimbursement system would pay for a new class of patented medicines, except for those rare cases not treated by the first two.
Their conclusion is even more depressing: “This general problem applies in diabetes, hypertension, cholesterol management and many other indications.” They also note that some of the decline of R&D productivity may be because pharma companies shifted from crowded (but high approval rate) therapeutic areas to less crowded (but lower approval rate) areas.
Basic Research/Brute Force
In this argument, the authors contend that the whole attempt to solve health problems through basic research and a molecular understanding of disease has been a disappointment, if not an outright failure. In addition to the molecular basis — and brute force analysis attempting to find new molecules — is also the assumption that the best way to solve a disease is to make a single molecule that binds to a single target.
Based on his industry experience, Lowe shows great sympathy for this argument
Conclusions
The issue of declining R&D efficacy is a huge one for the industry, and also for investors in pharma companies big and small. The authors list a number of reasons why they are optimistic in the next five years:
References
Gary Pisano, Science Business: The Promise, the Reality, and the Future of Biotech, Boston: Harvard Business School Press, 2006.
Jack W. Scannell, Alex Blanckley, Helen Boldon & Brian Warrington, “Diagnosing the decline in pharmaceutical R&D efficiency,” Nature Reviews Drug Discovery 11 (March 2012): 191-200. Doi: 10.1038/nrd3681
Rather than start from scratch, the team from Sanford C. Bernstein (an investment research company) summarize many of the previous diagnoses, noting the lack of incommensurability of the earlier proscriptions:
They include: the FDA’s ‘Critical Path Initiative’; a series of prescient papers by Horrobin, arguing that bottom-up science has been a disappointing distraction; an article by Ruffolo focused mainly on regulatory and organizational barriers; a history of the rise and fall of medical innovation in the twentieth century by Le Fanu; an analysis of the organizational challenges in biotechnology innovation by Pisano†; critiques by Young and by Hopkins et al., of the view that high-affinity binding of a single target by a lead compound is the best place from which to start the R&D process; an analysis by Pammolli et al., looking at changes in the mix of projects in ‘easy’ versus ‘difficult’ therapeutic areas; some broad-ranging work by Munos; as well as a handful of other publications.† The book by Gary Pisano (2006) of Harvard Business School is a favorite here at KGI — I think I’ve seen it on more shelves than any other.
There is also a problem of scope. If we compare the analyses from the FDA, Garnier, Horrobin, Ruffolo, Le Fanu, Pisano, Young and Pammolli et al., there is limited overlap. In many cases, the different sources blame none of the same countervailing forces. This suggests that a more integrated explanation is required.
The main point of the article is to introduce a so-called “Eroom’s Law”, in which the number of new FDA-approved therapies (per $ million R&D) fell by half every nine years. It is intended to be the inverse of the Moore’s Law that has driven IT improvements or more than 40 years, in which the number of transistors per chip doubles every two years.
The Eroom’s Law was the major new gimmick of the Scannell et al article, and Lowe devoted an entire posting to it. I’m far from convinced: unlike Gordon Moore, there’s no real explanation of the causal mechanisms — even post hoc. Instead, it seems more like Eroom’s Syndrome — a collection of symptoms with multiple root causes.
The four (possibly five) causes that the authors identified:
- “the ‘better than the Beatles’ problem;
- the ‘cautious regulator’ problem;
- the ‘throw money at it’ tendency; and the
- ‘basic research–brute force’ bias.
Some of these are dog-bites-man stories. The excess of caution by the FDA is like the weather — everyone complains about it but nobody does anything about it. Even though they mostly dismiss it, the “low-hanging fruit” argument is also an old one.
Interestingly, they argue that “throw money” is easily reversed: if, in effect, big pharma R&D shops had become fat, dumb and happy (my term not theirs), a prescription of lean and mean can be applied with little impact on output. If true, this would certainly help reverse the trend.
It’s the two remaining ideas that to me seemed the novel ones.
Better than the Beatles
This was I thought the most clever argument — both in its identification, and in its framing:
Imagine how hard it would be to achieve commercial success with new pop songs if any new song had to be better than the Beatles, if the entire Beatles catalogue was available for free, and if people did not get bored with old Beatles records. We suggest something similar applies to the discovery and development of new drugs. Yesterday's blockbuster is today's generic. An ever-improving back catalogue of approved medicines increases the complexity of the development process for new drugs, and raises the evidential hurdles for approval, adoption and reimbursement. It deters R&D in some areas, crowds R&D activity into hard-to-treat diseases and reduces the economic value of as-yet-undiscovered drugs. The problem is progressive and intractable.As they point out, content-based IP loses its novelty and so people seek out new things. After everyone saw Gone with the Wind, there was room for Casablanca, On The Waterfront, The Sound of Music, and a couple of Godfather movies. In resource based industries, the consumption of the old content (e.g. coal from a mine) makes the remaining holdings more valuable.
They point to a specific area — anti-ulcerants — as an example where drug discovery is held back by the back catalog. Two families of (now generic) solutions are already available, and while the third approach “would probably be safe and effective,” it is unlikely that any healthcare reimbursement system would pay for a new class of patented medicines, except for those rare cases not treated by the first two.
Their conclusion is even more depressing: “This general problem applies in diabetes, hypertension, cholesterol management and many other indications.” They also note that some of the decline of R&D productivity may be because pharma companies shifted from crowded (but high approval rate) therapeutic areas to less crowded (but lower approval rate) areas.
Basic Research/Brute Force
In this argument, the authors contend that the whole attempt to solve health problems through basic research and a molecular understanding of disease has been a disappointment, if not an outright failure. In addition to the molecular basis — and brute force analysis attempting to find new molecules — is also the assumption that the best way to solve a disease is to make a single molecule that binds to a single target.
Based on his industry experience, Lowe shows great sympathy for this argument
This gets us back to a topic that's come up around here several times: whether the entire target-based molecular-biology-driven style of drug discovery (which has been the norm since roughly the early 1980s) has been a dead end. Personally, I tend to think of it in terms of hubris and nemesis. We convinced ourselves that were were smarter than we really were.I lack both the science and the industry experience to assess the validity of this complaint, except to note that this critique is obviously not universally shared. It would be nice to think that this article would start an honest conversation, but my guess is that too much money (private, government, university) has been invested in molecular approaches for this idea to gain traction until the evidence is undeniable.
Conclusions
The issue of declining R&D efficacy is a huge one for the industry, and also for investors in pharma companies big and small. The authors list a number of reasons why they are optimistic in the next five years:
Flat to declining R&D costs, as well as a bolus of oncology drugs, more orphan drugs and 'biosimilars as BLAs', might put an end to Eroom's Law at an industry level. Whether this improves things enough to provide decent financial returns on the industry's R&D investment is a different question. Financial markets don't think so. Industry executives do.Their final idea is for each big pharma company to create a Chief Dead Drug Officer (CDDO), who is incentivized to analyze the failure of R&D investments and report the board and the public about the reasons beyond Eroom’s Law. A provocative idea — but I’m not holding my breath.
References
Gary Pisano, Science Business: The Promise, the Reality, and the Future of Biotech, Boston: Harvard Business School Press, 2006.
Jack W. Scannell, Alex Blanckley, Helen Boldon & Brian Warrington, “Diagnosing the decline in pharmaceutical R&D efficiency,” Nature Reviews Drug Discovery 11 (March 2012): 191-200. Doi: 10.1038/nrd3681
Thursday, March 8, 2012
How "Perfecting Medicine" will reshape the life science industry
At his talk this morning at KGI, Dr. Paul Billings argued that the vision for 21st century medicine needs to go beyond personalized medicine to “perfected medicine.”
The chief medical officer of Life Technologies, Billings started by reviewing where medicine was for centuries, and the progress that was made in the 20th century to improve upon that. He illustrated the 19th century state of the art with “The Doctor,” pained by Sir Luke Fildes after his son died in 1877 of tuberculosis. As an MD working for a life science company, Billings argued for a world that both keeps the personal attention of the caring physician while providing doctors with the best science for preventing and curing illness.
Unfortunately, while the 20th century brought many lifesaving therapeutics, the approach towards selecting and dispensing these therapies is remains one of “trial and error.” He showed a chart that failure rates for post-heart attack medications and mammographs of are more than 10%, while airline flights have a fatality rate of less than 1 PPM. Billings lamented that having hospitals "more like bagging handling is not what I'd like to see about healthcare delivery".
From the perspective of systems biology, a solution proposed for this existing paradigm has been proposed through approach of “4P medicine”: predictive, personalized, preventive, participatory.
However, Billings argues that we need to go further: "We want 1P medicine: perfected medicine.” Such an approach would rebuild healthcare from the ground up, to tailor solutions for individuals make choices based on scientific understanding. To support this vision, he cited the 2008 report of a presidential advisory board, “Priorities for Personalized Medicine.”
Billings wants sequencing to be more mainstream in healthcare, the way that imaging and other modalities are: "I don't want to be in the basement of hospitals any more — I want it to be on the ground floor”. (Of course, Billings works for one of the major vendors of sequencing products.)
Based on the research of Jonathan Rothberg (of Ion Torrent), DNA sequencing has shifted optical-based sequencing to semiconductor-based sequencing. For the audience, Billings waved around a DNA sequencer chip the size of a postage stamp. A $50k sequencer that in 2013 will soon do a sequence in 2 hours for a marginal cost of $1,000.
Billing predicted that the performance improvements by this CMOS-based sequencing will continue indefinitely — as did microprocessors — and allowing sequencing to shift from sequencing specific genes to whole genome sequencing. (Of course, there is the nagging problem of the cost of the data analysis to make sense of that data).
But, Billings argues, the benefits are not just limited to price. Instead of sequencing in batches and taking weeks, the results will come back in hours. Various conditions — such as a heart attack, TV or sepsis — need answers much much sooner than weeks to make the appropriate clinical intervention. Cheap sequencing will also allow applying therapeutics — especially expensive biologic compounds — only for those patients who will benefit.
In an era of limited resources for healthcare, there’s a need to also demonstrate this technology can (as in the case of Sir Luke’s personal tragedy) to deliver "outcomes that matter". He provided the example of the May 2011 fatal E. coli outbreak in Germany, in which a DNA sequencer was used to characterize the bacteria and develop a scalable screening process in less than a week. (See the PLOSone article for more info.)
This is going to be highly disruptive to existing business models. For example, when Billings put up a slide showing how a series of existing tests might eventually be replaced by a singled sequencing test, I immediately thought about all the buggy whip makers that are going to put out of business.
I raised this question during the subsequent panel discussion, a discussion that included Billings, Board of Trustees chairman (and health care VC) Bob Curry, Advisory Council member Russ Teagarden of Medco, and Professor Jim Osborne (formerly of Beckman Coulter).
To Billings, I suggested that if firm can’t sell diagnostic tests, they’ll try to extract patent royalties from their gene patents from companies that are selling the all-in-one tests. I’ve lived this world in my previous research, as it’s S.O.P. for cellphones and other parts of the telecom industry. Diagnosing human disease with a single whole genome test will bring patent stacking that will go far beyond any pocket-sized device (at least until the patents expire).
Billings noted that companies who have such gene patents are aware of the problem (although he doesn’t know or wouldn’t say what they think the solution is). As an example, he mentioned the controversial diagnostics company Myriad Genetics, whose sequencing of cancer genes has done so much to improve our understanding and treatment of breast cancer. (At lunchtime, we discussed whether the gene patenting industry needed an Apple to impose an iTunes-like pricing model, or whether it could organize an ASCAP or BMI to collect and allocate royalties among rightsholders).
Ready or not, the existing businesses are going to be disrupted in a classic Schumpeterian example of “creative destruction.“
On the other hand, based on past experience it seems unlikely that the US regulatory bureaucracy — or the rest of the healthcare payment or delivery system — are ready to be disrupted. As Advisory Council member Weaver Gaines put it, it takes 20 years for a new medical approach to be adopted — or even a generation for the old guard to die off.
Bob Curry was a little more optimistic about FDA cooperation due to the pressure it will face from regulatory arbitrage: if the US won’t approve new approaches, then other countries — like Denmark or Switzerland — will.
However, adoption of a new paradigm also requires acceptance by healthcare providers and also healthcare payers. Both Teagarden and Curry noted the delays (and often unrealistic evidentiary expectations) required to get payers to agree to reimburse for diagnostics. The panel agreed that adoption will increasingly require that new approaches not only save lives, but also save money.
The panel also discussed the challenge of getting new practice accurately explained and adopted by frontline health providers. Curry pointed to the ongoing trend for doctors to leave their individual practices and affiliate with regional hospital groups, which he predicted would make it easier both to reach and to incentivize these M.Ds. to adopt the new scientific paradigm.
Photo credit: “The Doctor” (1891) by Sir Luke Fildes, courtesy of Wikimedia Commons.
The chief medical officer of Life Technologies, Billings started by reviewing where medicine was for centuries, and the progress that was made in the 20th century to improve upon that. He illustrated the 19th century state of the art with “The Doctor,” pained by Sir Luke Fildes after his son died in 1877 of tuberculosis. As an MD working for a life science company, Billings argued for a world that both keeps the personal attention of the caring physician while providing doctors with the best science for preventing and curing illness.
Unfortunately, while the 20th century brought many lifesaving therapeutics, the approach towards selecting and dispensing these therapies is remains one of “trial and error.” He showed a chart that failure rates for post-heart attack medications and mammographs of are more than 10%, while airline flights have a fatality rate of less than 1 PPM. Billings lamented that having hospitals "more like bagging handling is not what I'd like to see about healthcare delivery".
From the perspective of systems biology, a solution proposed for this existing paradigm has been proposed through approach of “4P medicine”: predictive, personalized, preventive, participatory.
However, Billings argues that we need to go further: "We want 1P medicine: perfected medicine.” Such an approach would rebuild healthcare from the ground up, to tailor solutions for individuals make choices based on scientific understanding. To support this vision, he cited the 2008 report of a presidential advisory board, “Priorities for Personalized Medicine.”
Billings wants sequencing to be more mainstream in healthcare, the way that imaging and other modalities are: "I don't want to be in the basement of hospitals any more — I want it to be on the ground floor”. (Of course, Billings works for one of the major vendors of sequencing products.)
Based on the research of Jonathan Rothberg (of Ion Torrent), DNA sequencing has shifted optical-based sequencing to semiconductor-based sequencing. For the audience, Billings waved around a DNA sequencer chip the size of a postage stamp. A $50k sequencer that in 2013 will soon do a sequence in 2 hours for a marginal cost of $1,000.
Billing predicted that the performance improvements by this CMOS-based sequencing will continue indefinitely — as did microprocessors — and allowing sequencing to shift from sequencing specific genes to whole genome sequencing. (Of course, there is the nagging problem of the cost of the data analysis to make sense of that data).
But, Billings argues, the benefits are not just limited to price. Instead of sequencing in batches and taking weeks, the results will come back in hours. Various conditions — such as a heart attack, TV or sepsis — need answers much much sooner than weeks to make the appropriate clinical intervention. Cheap sequencing will also allow applying therapeutics — especially expensive biologic compounds — only for those patients who will benefit.
In an era of limited resources for healthcare, there’s a need to also demonstrate this technology can (as in the case of Sir Luke’s personal tragedy) to deliver "outcomes that matter". He provided the example of the May 2011 fatal E. coli outbreak in Germany, in which a DNA sequencer was used to characterize the bacteria and develop a scalable screening process in less than a week. (See the PLOSone article for more info.)
This is going to be highly disruptive to existing business models. For example, when Billings put up a slide showing how a series of existing tests might eventually be replaced by a singled sequencing test, I immediately thought about all the buggy whip makers that are going to put out of business.
I raised this question during the subsequent panel discussion, a discussion that included Billings, Board of Trustees chairman (and health care VC) Bob Curry, Advisory Council member Russ Teagarden of Medco, and Professor Jim Osborne (formerly of Beckman Coulter).
To Billings, I suggested that if firm can’t sell diagnostic tests, they’ll try to extract patent royalties from their gene patents from companies that are selling the all-in-one tests. I’ve lived this world in my previous research, as it’s S.O.P. for cellphones and other parts of the telecom industry. Diagnosing human disease with a single whole genome test will bring patent stacking that will go far beyond any pocket-sized device (at least until the patents expire).
Billings noted that companies who have such gene patents are aware of the problem (although he doesn’t know or wouldn’t say what they think the solution is). As an example, he mentioned the controversial diagnostics company Myriad Genetics, whose sequencing of cancer genes has done so much to improve our understanding and treatment of breast cancer. (At lunchtime, we discussed whether the gene patenting industry needed an Apple to impose an iTunes-like pricing model, or whether it could organize an ASCAP or BMI to collect and allocate royalties among rightsholders).
Ready or not, the existing businesses are going to be disrupted in a classic Schumpeterian example of “creative destruction.“
On the other hand, based on past experience it seems unlikely that the US regulatory bureaucracy — or the rest of the healthcare payment or delivery system — are ready to be disrupted. As Advisory Council member Weaver Gaines put it, it takes 20 years for a new medical approach to be adopted — or even a generation for the old guard to die off.
Bob Curry was a little more optimistic about FDA cooperation due to the pressure it will face from regulatory arbitrage: if the US won’t approve new approaches, then other countries — like Denmark or Switzerland — will.
However, adoption of a new paradigm also requires acceptance by healthcare providers and also healthcare payers. Both Teagarden and Curry noted the delays (and often unrealistic evidentiary expectations) required to get payers to agree to reimburse for diagnostics. The panel agreed that adoption will increasingly require that new approaches not only save lives, but also save money.
The panel also discussed the challenge of getting new practice accurately explained and adopted by frontline health providers. Curry pointed to the ongoing trend for doctors to leave their individual practices and affiliate with regional hospital groups, which he predicted would make it easier both to reach and to incentivize these M.Ds. to adopt the new scientific paradigm.
Photo credit: “The Doctor” (1891) by Sir Luke Fildes, courtesy of Wikimedia Commons.
Tuesday, February 28, 2012
KGI's related diversification: PharmD in pharmacogenomics
Like corporations, universities (and other nonprofits) often pursue related diversification to leverage existing assets and achieve economies of scope. Today the Keck Graduate Institute of Applied Life Sciences announced its planned partnership with another LA-area private college, Chapman University, to launch a new graduate pharmacy school in Fall 2014.
I don’t know as much about Chapman, but at KGI it’s a chance to leverage our understanding of human healthcare, business, our labs, our researcher and our industry connections (among other things). It’s an exciting opportunity for KGI to do more to fulfill our mission to translate into practice the power and potential of the life sciences for the benefit of society.
Here is the official announcement:
KGI Partners with Chapman University for New School of BioPharmacy
Innovative School of BioPharmacy, set to open in 2014 in collaboration with Chapman University, rethinks the role of the 21st century pharmacist.
February 28, 2012
The presidents of Chapman University and Keck Graduate Institute (KGI) have announced plans to establish a joint School of BioPharmacy, initially launching at the KGI campus in Claremont, California. The school will focus on preparing graduate pharmacists for professions in biotechnology and the pharmaceutical industry as well as for modern pharmacy practice. The school will open in fall 2014, pending national accreditation.
"This collaboration is a remarkable opportunity," said James L. Doti, president of Chapman University. "It builds on KGI's innovative professional master's and postdoctoral programs and close biotechnology and pharmaceutical industry ties, and takes advantage of Chapman's strengths in computational sciences and entrepreneurship."
The new Chapman-KGI School of Biopharmacy will reorient the Doctor of Pharmacy degree toward crucial developments in pharmacogenomics. The program will reflect rapidly developing changes in the field, including the growth of personalized medicine, the delivery of biomolecules, changes in drug and device development, and progress in clinical trials and team-based operating environments. The curriculum is planned to equip graduates to become licensed pharmacists with sophisticated knowledge of the applied life sciences for modern health care practice, and experience with therapeutics, therapy management, and regulatory affairs to shape discovery in biotechnology and pharmaceutical companies. The school's vision reflects the ways in which pharmacists are increasingly asked to shoulder a primary role in matching drugs and therapies to a particular patient or strain of illness, as well as translating their clinical expertise into drug discovery in industry.
"The Chapman-KGI School of BioPharmacy will embrace this change in the profession," said Sheldon Schuster, president and professor of biochemistry at Keck Graduate Institute. "Current advances in genomics and the growing convergence of therapeutics, diagnostics and medical devices are creating new opportunities for pharmacists in the life-sciences industry and modern clinical practice. This new school will help prepare highly qualified individuals to take advantage of those opportunities."
The two universities have begun a national search for an entrepreneurial founding dean with experience in pharmacy education and industry. The first classes for the Chapman-KGI School of BioPharmacy will be held on the KGI campus in Claremont, while Chapman pursues construction of a 120,000-square-foot Science Center in the City of Orange. The new Science Center will house Chapman's portion of the School of BioPharmacy and the university's Schmid College of Science and Technology. KGI is planning a major capital campaign that will expand facilities for ongoing teaching, research programs and the Chapman-KGI School of BioPharmacy, which is expected to grow to a full enrollment of 320 students in the four-year PharmD program.
Keck Graduate Institute of Applied Life Sciences is a member of The Claremont Colleges. Along with other highly regarded graduate programs, KGI offers an innovative professional master's program that integrates rigorous science with business, clinical trial management and regulatory affairs. KGI represents The Claremont Colleges' first entry into graduate-level, application-based scientific research and education. It remains the only graduate institute in the country with this sole focus.
Tracing its history to 1861, Chapman University is one of California's oldest and most respected private institutions. The university is known for its commitment to deeply engaged learning, providing its 7,000 students with a remarkable educational environment from the moment they step onto campus. Chapman offers bachelor degrees in 47 majors, and graduate or terminal degrees in law, education, film, business, economics, the humanities and science.
I don’t know as much about Chapman, but at KGI it’s a chance to leverage our understanding of human healthcare, business, our labs, our researcher and our industry connections (among other things). It’s an exciting opportunity for KGI to do more to fulfill our mission to translate into practice the power and potential of the life sciences for the benefit of society.
Here is the official announcement:
KGI Partners with Chapman University for New School of BioPharmacy
Innovative School of BioPharmacy, set to open in 2014 in collaboration with Chapman University, rethinks the role of the 21st century pharmacist.
February 28, 2012
The presidents of Chapman University and Keck Graduate Institute (KGI) have announced plans to establish a joint School of BioPharmacy, initially launching at the KGI campus in Claremont, California. The school will focus on preparing graduate pharmacists for professions in biotechnology and the pharmaceutical industry as well as for modern pharmacy practice. The school will open in fall 2014, pending national accreditation.
"This collaboration is a remarkable opportunity," said James L. Doti, president of Chapman University. "It builds on KGI's innovative professional master's and postdoctoral programs and close biotechnology and pharmaceutical industry ties, and takes advantage of Chapman's strengths in computational sciences and entrepreneurship."
The new Chapman-KGI School of Biopharmacy will reorient the Doctor of Pharmacy degree toward crucial developments in pharmacogenomics. The program will reflect rapidly developing changes in the field, including the growth of personalized medicine, the delivery of biomolecules, changes in drug and device development, and progress in clinical trials and team-based operating environments. The curriculum is planned to equip graduates to become licensed pharmacists with sophisticated knowledge of the applied life sciences for modern health care practice, and experience with therapeutics, therapy management, and regulatory affairs to shape discovery in biotechnology and pharmaceutical companies. The school's vision reflects the ways in which pharmacists are increasingly asked to shoulder a primary role in matching drugs and therapies to a particular patient or strain of illness, as well as translating their clinical expertise into drug discovery in industry.
"The Chapman-KGI School of BioPharmacy will embrace this change in the profession," said Sheldon Schuster, president and professor of biochemistry at Keck Graduate Institute. "Current advances in genomics and the growing convergence of therapeutics, diagnostics and medical devices are creating new opportunities for pharmacists in the life-sciences industry and modern clinical practice. This new school will help prepare highly qualified individuals to take advantage of those opportunities."
The two universities have begun a national search for an entrepreneurial founding dean with experience in pharmacy education and industry. The first classes for the Chapman-KGI School of BioPharmacy will be held on the KGI campus in Claremont, while Chapman pursues construction of a 120,000-square-foot Science Center in the City of Orange. The new Science Center will house Chapman's portion of the School of BioPharmacy and the university's Schmid College of Science and Technology. KGI is planning a major capital campaign that will expand facilities for ongoing teaching, research programs and the Chapman-KGI School of BioPharmacy, which is expected to grow to a full enrollment of 320 students in the four-year PharmD program.
Keck Graduate Institute of Applied Life Sciences is a member of The Claremont Colleges. Along with other highly regarded graduate programs, KGI offers an innovative professional master's program that integrates rigorous science with business, clinical trial management and regulatory affairs. KGI represents The Claremont Colleges' first entry into graduate-level, application-based scientific research and education. It remains the only graduate institute in the country with this sole focus.
Tracing its history to 1861, Chapman University is one of California's oldest and most respected private institutions. The university is known for its commitment to deeply engaged learning, providing its 7,000 students with a remarkable educational environment from the moment they step onto campus. Chapman offers bachelor degrees in 47 majors, and graduate or terminal degrees in law, education, film, business, economics, the humanities and science.
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