How Brexit changed the way I look at biopharma’s reputation problem

This piece originally appeared in the Timmerman Report.

You may have heard something recently about Britain, the European Union (EU), some vote or other, chaos, turmoil, blah, blah, blah…You might also have heard how the presumptive Republican nominee for President of the United States has gotten to that position by identifying a strong thread of anti-establishment, populist sentiment in the US. And you may have heard that biotech and pharma is suffering from a reputation problem.

One of these things is not like the other, right?

I’m not so sure.

That biopharma has a reputation problem isn’t in doubt. The question, though, is how the industry got here. I want to know this because, thinking like many drug developers, I believe that by knowing the cause of a condition a fix can more easily be found.

There have been numerous candidate reasons, and I’m open to the idea that the cause is multifaceted just like it is for many chronic diseases. In the past year alone we’ve had the Martin Shkreli circus, admonishments about drug pricing from political candidates, analyses of how yearly increases in pricing often outstrip inflation, Pfizer pursuing quizzical acquisitions to avoid paying taxes, and companies suing the FDA to prevent generic competition. Biopharma’s problems go further back, as well, and examples of less than exemplary behavior abound. Hey, I was working at Merck when Vioxx was happening.

But Brexit points to something else. While it makes sense to look for behaviors by biopharma for causes for the reputation problem, business doesn’t happen in a vacuum. Political and social trends over the past few years suggest a rejection of elite opinion and earned expertise that is touching many parts of society and culture. Derek Lowe at In the Pipeline had a recent fascinating post on this phenomenon in the context of Right to Try laws (and also delving into Trump and Brexit). As he points out, Right to Try laws sit in that thorny spot where technological knowledge of drug development and Libertarian impulses collide. I can come up with a half dozen reasons why I think Right to Try laws are in general a bad idea, and none of them will sway someone who wants access to an experimental therapy for their dying child. You can see this playing out in the debate about whether eteplirsen should be approved for Duchenne Muscular Dystrophy.

Where did this suspicious, and sometimes hostile, reaction to elites and expert opinion come from? MSNBC anchor Chris Hayes, among others, has posited that over the past several years many people have suffered the effects of broken promises and crippled expectations. If the social contract between elites and the rest of the population is that if the elites (whether they are Democrats or Republicans) are given power, everyone will benefit, then breaking that contract leads to disillusionment and, eventually, rejection. A similar analysis from another part of the political spectrum was made by Charles Murray (H/T to @ScottGottliebMD). One can also point to growing partisanship as, if not causal, at least maintaining and contributing to the diminishment of expert and elite opinion. Unfortunately, there is no precision discrediting. When one calls to question the statements of scientists on specific topics such as global warming or vaccinations, one tars with a broad brush and the whole scientific edifice takes a hit. It’s like those kids with the paint rollers in Splatoon.

From this perspective, the poor reputation of biopharma stems at least in part from larger societal trends in how people perceive expertise. Healthcare is highly complicated and technical, and it’s not a stretch to say it’s associated with the expert and the elite. Taking this perspective has some good and some bad implications for biopharma. On the good side, one can say it’s not (all) the fault of the biopharma companies’ specific actions that the industry’s reputation has suffered. But on the bad side, this makes it that much harder to fix the problem. Better general overall behaviors by companies are a prerequisite for improving biopharma’s rep, but not the final cure.

However, if biopharma is serious about its reputation, and buys into this theory, it could use this perspective in a few ways.

First, it can look at the one industry that is highly expert driven and still has a good reputation: high technology, as represented by companies like Apple and Amazon, among others. I would conjecture that these companies, by taking a very consumer-focused approach and a real dedication to innovation, simply show people repeatedly, several times a day, that they are trustworthy and worth the money. Now, this is hard to do in biopharma where product development cycles are pretty much the diametric opposite of the fail fast, hard and often ethos found in Silicon Valley companies. But the industry can do a better job of explaining its innovative and impactful products, and being honest about when new products have neither—and pricing them accordingly.

The second thing is biopharma could start taking a longer, more societally focused view in how it uses its considerable lobbying muscle. To take one example, many in the US (and Europe) feel betrayed by the obvious effects of globalization on unemployment in some job sectors. Those in favor of globalization routinely argue that everyone benefits from cheaper prices on manufactured goods and also that hundreds of millions of people in the developing world are seeing a substantial increase in their living standards. This is measurably true. It’s also an argument that doesn’t resonate at all with someone who trained and worked as a machinist for fifteen years and lost her job due to outsourcing. There’s an asymmetry in perceived benefit versus experienced insult and loss

Biopharma could push for greater investments in job retraining, in both the public and private sectors, as well as for extensions to programs such as unemployment benefits to allow people the time to get retrained. You might say that this is outside the scope of what biopharma is responsible for, but that’s a self-imposed limit. One of the arguments for why elites and experts have lost their status is that so many organizations seem to be concerned solely with narrowly defined self-interest and shareholder value; not with the workers, customers and society within which they operate.

It’s a problem, figuring out the best way to rehabilitate biopharma’s rep, but it’s a necessary one to solve for the industry’s long term health. The Trump and Sanders campaigns have demonstrated that there are large reservoirs of resentment out there that shouldn’t be ignored. And it’s not hopeless either. Large scale societal change in attitudes can be done. Canada, unlike much of the developed world, has created a culture welcoming of immigrants, and this was accomplished via a long standing, coordinated effort by the Canadian government and others to make openness a core Canadian trait. They persisted and took the long view. If biopharma can spend decades and billions of dollars in dogged pursuit of specific targets (I’m looking at you, amyloid beta), then perhaps it can do the same to try and change the environment in which we all live and work.

 

No, CRISPR-Cas won’t save the day for ag biotech

You want to know how to drive a scientist crazy? Insist that you believe something that’s not supported by current scientific evidence. Tell her vaccines cause autism, or creationism is just as valid a theory as evolution, or that climate change isn’t really happening, I mean, after all, a monster blizzard hit Washington DC this January! Global warming, pssh…

There’s an old episode of Friends that did a good job of showing how this kind of conversation goes. Phoebe professes not to believe in evolution and Ross, a paleontologist, keeps trying to convince her that evolution is real using scientific evidence and logic. He grows increasingly frustrated and insistent as she continues to deny the basis of his life’s work, finally losing it when she goads him into admitting (like a good scientist) that even theories like evolution are not immune from questioning and testing.

We train scientists to carefully generate, weigh and use evidence. To no one’s surprise, this leads many scientists to generalize and think that in all matters having to do with the physical world we all should and of course will follow the evidence. Yes, sometimes that leads to unpopular ideas, and sometimes the ideas change as the weight of evidence changes. This training can make scientists kind of boring at cocktail parties. Still, the overall scientific process keeps moving forward and it’s because of this reliance on evidence.

But many people (including, at times, even some scientists) don’t always think the same way about things in the physical world. And that’s why I’m pessimistic that CRISPR-Cas technology will peacefully resolve the Genetically Modified Organism (GMO) debate. Continue reading

Some MLK Day thoughts about evolution, teachable moments, and being human

Maybe my favorite episode of Northern Exposure is the one where Maurice Minnifield (played by the great Barry Corbin), the bigoted, pompous, ex-astronaut is surprised to discover he has a son, Duk Won, conceived during service time in Korea. After grudgingly admitting that Duk Won’s claim is real, Maurice has a conversation with Chris, the town’s DJ and amateur philosopher, about how difficult this is. Their conversation concludes something like this:

Maurice: I wouldn’t have had such a problem with this if only…

Chris: If only he were white?

Maurice: …Yeah…

Chris: Well, that’s a reason for hope.

Maurice: What? What are you talking about?

Chris: Because racism is a learned behavior. And that means it can be unlearned. Continue reading

Is Opower the model for getting us to wellness and health?

This is a post about nudges. And optimism.

There’s a story I read a long time ago by David Brin. It’s called “The Giving Plague,” and the protagonist is a virologist and epidemiologist who describes his life working on viruses and vectors. The Plague of the title is a virus that has evolved the ability to make infected people enjoy donating blood. Recipients keep giving blood, leading to an exponentially expanding network of people who find themselves giving blood regularly and even circumventing age and other restrictions to make sure they can give their pint every eight weeks.

The central twist of the story is that the protagonist’s mentor, who discovers this virus, realizes people who donate blood also perform other altruistic acts–that the act of giving blood changes their own self image. Makes them behave as better people. And so he suppresses the discovery, for the greater good of society. The protagonist, a rampant careerist, begins plotting murder to allow him to take credit. But before he can act, more diseases strike, the Giving Plague moves through the population, and the protagonist forgets about it in his efforts to cure newer diseases.

And if anyone thinks something like this is too outlandish, I encourage you to read this piece about Toxoplasma gondii and how it makes infected mice charge at cats, the better to be eaten so that T. gondii can spread. Yeah.

But what does this story have to do with the future of wellness and health?

Continue reading

Trying to figure the way through a 401(k) life

Thomas Friedman’s thoughts on how we’re becoming a 401(k) nation have been kicking around the back of my mind for about a year. His Op-Ed piece described the shift in how retirement plans in the US have largely shifted from pensions to 401(k)s and used that transition to make a point about the changing nature of work.

In a pension plan, a defined input (so many year of work) leads to a defined output (a regular payment that starts upon retirement until the day you die) with the risk assumed by the employer. In a 401(k), there’s still a defined input (regular deposits into a managed investment account) but how much a person gets at the end carries no guarantees and the risk sits squarely with the employee.

Friedman’s insight was that work itself is following that same path. Where once the defined achievements of education and learned skills were enough to guarantee continued employment and a good, middle-class career (at least), that’s not really the case anymore.

The news a some months back that Amgen will be closing its Seattle site this year really drove that point home. It was a reminder that biopharma, like so many other industries, isn’t immune to the implications  of the 401(k) life.

Continue reading