Undervalued assets in biopharma hiring: Adaptability

All opinions are my own and do not necessarily reflect those of Novo Nordisk.

A night of fantasy baseball goes horribly awry

This season I had a spectacularly poor fantasy baseball auction draft.  It was my own fault.  For those of you unfamiliar with fantasy sports, a group of friends create teams by selecting players from a real sports league and track their performance over the season.  The better your players perform, the better you do in your league.  Many leagues, like ours, select players by means of an auction draft.  Everyone gets a certain amount of virtual money to bid on different players, and you use that finite amount of money to fill out your roster.

On the night of our draft, because I had made plans to go out, I set up the auction software with a bunch of default values for different players.  Basically, amounts that I was willing to bid up to for each.  This is called robo-drafting.   I thought I’d set my boundaries well.

I was wrong. Continue reading

Dealing with disruption: publishing houses and drug development

All opinions are my own and do not necessarily reflect those of Novo Nordisk.

I currently have about ten books strewn about my apartment, in various stages of being read.  Many I’ve been working through, on and off, for over a year.  And something that people keep asking me as they look around is, why don’t I just get a Kindle?  Part of the reason is that I’m cheap.  Also, I get a lot of my books from the library, and I get real pleasure from walking to the neighborhood library, checking out books, holding them and leafing through them, wandering up and down the aisles and also paying fines.  Lots of fines.  Which is okay, because the libraries need all the help they can get.  Although in counterpoint to that, a recent article from the Seattle Times described how in many ways libraries are still popular, even among younger people.

But I know that one day, probably pretty soon, I’ll succumb like a largemouth bass to the glowing lure of an electronic reader.  It makes too much sense.  I can still go the library, but it may be just for ideas of what I can purchase, or at least obtain electronically through the library’s ebook collection.  This is the literary world that the internet has enabled.  And it’s making life very difficult for the publishing houses.

When we talk about the changes technology enables, we know it’s messy.  There are disruptions, and there are often winners and losers.  Not because anyone is out to get anyone else, but just because environments select and support specific traits, and when those environments change, many of those traits no longer are adaptive.  We don’t have woolly mammoths because a combination of human hunting and warming climates most likely did them in; their environment changed.  The book publishing industry is in the middle of change due to new and different ways of marketing books, and to the rise of ebooks versus physical copies.

I’ve written before in this blog about drug development and how it can find parallels in other industries, and a recent article in WIRED really resonated.  Let me put down some quotes from the article, and see if they sound familiar:

“…awarding huge contracts for books that may not even be written yet creates tremendous risk.”  and “Predicting the success or failure of any given book is impossible.”  Hmm, replace books with “pre-clinical/early clinical stage drugs” and this is a familiar complaint by pharma.

“The publishing houses stay afloat only because the megahits pay for the flops, and there’s generally enough left over for profits.”  Yep, sounds familiar as a business plan.

“In the long term, what publishers have to fear the most may not be Amazon but an idea it has helped engender–that the only truly necessary players in the game are the author and the reader.”  To me, this speaks to the changing dynamic of drug development, where patient groups are using new internet tools to become more active players in the drug development process.

“The recently announced merger of the two biggest of the Big Six, Random House and Penguin, is widely seen as a move to build an entity that can stand up to Amazon’s market power.”  Now where have I seen mergers done as a business ploy before?

Drugs are not just like ebooks (although my post earlier this week did look at the concept of drugs as information). But drug development faces the same crisis of old ways of doing business not being sufficient to tackle new challenges brought about by changing environments.  In the case of drug development, the disruption is coming from the challenge of creating new, more effective drugs despite increasing regulatory requirements.  Can drug development learn anything from the problems the publishing houses are facing?

Unfortunately, as can be seen by the quotes above, so far the publishing industry doesn’t appear to have any new, magic bullet solutions that can teach the pharma business about dealing with disruption to old business models.   I suppose the key lesson, which many pharma and biotech already seem to be taking, is that adaptability is going to be a necessary component of business strategy moving forward.  Another possible lesson is that book publishers are having to ask what they’re really good at, and seeing how that can be adapted to a new world where authors have more power because they have new ways of reaching the reader.  Publishers are touting that they can provide the added value of savvy marketing and crackerjack editing to make themselves attractive to authors.  Even though we talk about social media as removing the need for traditional marketing, successful marketing is a skill however it’s accomplished, and a skill most authors don’t have and many don’t want to learn.

Pharma can similarly look at what they do best–clinical trials, sales and marketing–and possibly move out of the discovery part of things altogether.  It would be a radical change, but ignoring changing external factors and keeping the same business practices is unlikely to work in the long run.

Interestingly, in publishing I think the big winners when the dust settles might be…libraries!  While people want to buy books online, they still like to leaf through them.  You see the same phenomenon, by the way, with places like Best Buy.  People like to go see the physical item before hunching over their smartphone and doing one-click shopping.

This is leading to many bookstores becoming the de facto showroom for Amazon, and subsequently going out of business.  And when there are no neighborhood bookstores, people may turn even more to their local libraries.  There, they can not only see and leaf through books, but also talk to a friendly librarian without guilt and get recommendations.  One of the many things librarians excel at is navigating information and matching you up with the right book.  I wonder if we might eventually see librarians working on a partial commission basis, with you “tipping” them via Square or some other form of electronic money.  If we can download a song on impulse for 99 cents, wouldn’t we be willing to grant our librarians at least that much for helping us find the perfect novel?

Getting patients back to normal

All opinions my own and do not necessarily reflect those of Novo Nordisk.

Inspired in part by this column from David Shaywitz

Here is a story I had the privilege to hear from Fred Modell, one of the founders of the Jeffrey Modell Foundation (check them out; they’re a great group):  Fred was at their annual picnic, where they host kids with immune system defects.  Fred walked by two early teenage girls, and as he passed by he heard one of them asking the other, “You really kissed a boy?”  Which seems like a common enough thing for two teenage girls to be talking about.

Only in this case it wasn’t.  If your immune system doesn’t function like most everyone else’s, then kissing a boy is not just part of growing up.  It can be dangerous to your health. It’s something  about which you have to think hard, and try your best to understand the implications, and you need to be careful, cautious and measured.  Everything your first kiss really shouldn’t be.

For these girls, though, because of groups like the Modell Foundation and the treatments they’ve helped pioneer and support, these girls could experience the spontaneity of an event that so many kids take for granted.  And they could feel normal, like their friends in school. Continue reading

3D printers, DIY Bio, French bistros and one possible future path for drug development

All opinions are my own and do not necessarily reflect those of Novo Nordisk

The Long Tail is Everywhere There’s Information

Several years ago I happened upon Chris Anderson’s great book The Long Tail.  He wrote about the amazing changes that were taking place in commerce because of the digitization and electronic dissemination of information.  Mix incredibly cheap (essentially free) data storage with the Internet and reasonable bandwidth, throw in the power of search and individual customization algorithms, and suddenly business models no longer had to rely on bulk consumption and the generation of popular hits.

The first industries to feel the change were in entertainment:  music, movies, books, where having a physical copy was once necessary to enjoy Madonna, Star Wars, or Carl Hiaasen’s latest thriller.  Digitization turned that upside down.  It became clear that what we’re really paying for is information, and it’s a lot harder for the entertainment industry (or any industry) to keep control over the dissemination of information than when they sold that information packaged in shiny plastic discs.

Anderson also described how in this digital world, and aided by the powers of personalized search, niche markets could not only survive but thrive.  Once, something like Tuvan Throat Singing was a niche musical form that you might have heard of on a trip to Siberia, but you’d have had no luck finding a CD at your local Tower Records (remember them?).  Now, you can not only find several tracks from iTunes or Amazon, you’ll also get suggestions for what else you might like based on your fondness for overtone singing.  Since it costs Amazon basically nothing to store the music and associated information, they can afford to have it available for the 20 people who might want to buy it.  Tally that up across all the niches in the world and it’s a hefty sum.

This is pretty neat.  But it’s still uncertain how the business of entertainment will shake out financially and logistically among the producers, distributors and promoters.  I’m not real fond of chaos like that in my professional life, and for a long time felt secure that my job–drug development scientist–was not in danger of becoming part of a long tail phenomenon.  Only now I’m not so sure. Continue reading

Fielding percentage for UK surgeons

All opinions are my own and do not necessarily reflect those of Novo Nordisk.

Last week I posted on how our measurements of defense in baseball have become a lot more sophisticated, and how that gave me hope for the evaluation of innovation.  If baseball, one of the most tradition-bound of US sports can adopt to new metrics, surely business can too.

I was reminded of this with the publication of a recent article about the National Health Service (NHS) in the United Kingdom and their plan to publicize the surgical success rates of clinicians across their country.  Surgeons in eight different specialities will have their mortality rates for specific procedures, length of hospital stays post surgery, and other elements published in tables for anyone to access.  The first group to have this information released is vascular surgeons.

A fascinating aspect of how this is being done is that publication of one’s rates is voluntary, but if a surgeon chooses not to have his or her rates published, that surgeon will be named.  It’s not quite putting people into stocks in the public square, but it is definitely a form of public shaming meant to increase participation.

Nevertheless, six surgeons have opted out and been named.  Game theory might predict these are surgeons on the low end of the measured metrics, who are taking a calculated risk that the negatives associated with not publishing their rates are less than the negatives that would come with disclosure of their rates.  But that’s not the case.  The NHS has stated that none of these surgeons lie outside the normal range for the reported metrics.

Instead, these doctors are protesting that the metrics are not measuring the right things.   They suggest the metrics don’t take into account the subtleties involved in surgical cases, how procedure names alone don’t properly capture how difficult or easy a procedure might be for a given patient.  Are there comorbidities?  Is a patient in generally poor health?  Is a surgeon one who specializes in tricky, difficult cases which would therefore lead to a lower success rate even though the surgeon him or herself might be highly skilled and effective?  Could these metrics scare new surgeons away from performing more difficult procedures?

This echoes the debate about defense in baseball, and whether standard metrics such as fielding percentage are the best for measuring defensive ability, or if more elaborate measures better reflect reality.

Still, while I agree with the viewpoint that we should always try to improve metrics, I also think the NHS is doing the right thing.  I think in this case the proper analogy might be baseball defense back at the time before the invention of fielding percentage.  In the practice of medicine world-wide there is a surprising lack of information about measures like success rates and efficacy.  As Sir Bruce Keogh said to the BBC: “This has been done nowhere else in the world, and I think it represents a very significant step.”  To take another quote from the article, Professor Ben Bridgewater commented, “We’ve been collecting data on cardiac surgery since 1996 and we’ve been publishing it at individual surgeon level since 2005, and what we’ve seen associated with that is big improvements in quality: the mortality rates in cardiac surgery today are about a third of what they were ten years ago.” That which we don’t measure, we can’t improve.

In the US, that idea is becoming more prominent.  Recent articles in Time and the New York Times have highlighted how transparency is lacking in the United States healthcare system, and the Obama Administration’s emphasis on comparative effectiveness is another thrust in that direction.  What the NHS is doing is a great model and a great start, and I hope they continue to both make these aspects of healthcare more transparent and work to refine their metrics so that they accurately reflect the difficulty of practicing good medicine.