Last week Endeavor Greece hosted an Ask Me Anything session with Dr. Stelios Papadopoulos, Chairman of the Board of Directors at Biogen, on the future of health and pharma innovation. Dr. Papadopoulos has become the epitome of a passionate innovator in the pharmaceuticals field with his experiences as a research analyst, a biotech founder, and the Chairman of BoD of a Big Pharma company. He offered many insights on the latest trends in therapeutics including, digitalization in Pharma and how to develop potential partnerships with big pharma companies, upcoming trends in pharma, and finding & retaining top talent to make innovation happen.
When asked what is next in the pharmaceutical industry and how it could evolve, Stelios Papadopoulos responds by saying that as of right now, the biggest issue in the industry is drug pricing. He claims that the industry used to be separated in thirds in terms of who has the majority of the market, and now the market is sound 60-40, the US owning 60% of the drug market. He said that the industry lost some of the momentum in the emerging markets like China, which had a bit of potential, but since they have such strict pricing policies it was difficult to tap into.
He goes on to say that the US healthcare industry and system in terms of payments of drugs are very complex and there are very few people who know the ins and outs in terms of how the money flows.
“If tomorrow, prices of drugs in the US were cut in half, the industry would collapse”
The industry is not prepared to deal with a significant loss of margin and that’s the real problem. The system is so complicated to the point that it’s extremely difficult to change, and there is not enough political will to have legislation make changes and revamp the system. The interest is there, as it is a bipartisan objective to decrease drug prices. Both democrats and republicans in a sense agree that it would be smart for them to lead on some form of price control. It’s difficult, he says, but if it happens we’ll be in trouble.
Stelios believes that in the next 3-5 years, the future of the industry will be in gene therapy and cell therapy. Gene Modification approaches will do well as they are fascinating and scientifically exciting topics, although he is not convinced yet that they are ready for primetime real-time applications. Meaning, that we won’t be able to consistently treat patients with gene modification approaches because we just don’t know enough yet. This could be due to the complications that could arise and appear due to the genetic modifications, as it’s hard to tinker with the fundamental DNA of a patient. An example of a complication he’s seen, is cancer arising.
Stelios talks a bit about how one should go about communicating with pharma companies in order to maximize your chances of doing something or minimizing the two-year-long process. Big companies, pharma included, are all somewhat bureaucratic in nature and it’s hard to get them to move faster logistically. There’s not a big sense of urgency and there is always lots of deliberation. The practical ways, he believes, of trying to minimize the long process is contacting a committee and finding the people within them who are interested in what you have. They will navigate the project faster than if you were to go through committee after committee. Second, whatever service you want to provide to pharma, you need to sell it as a problem that they also perceive to be a problem.
Stelios explains that it’s not necessarily the timing of when the product will come out and be ready for the market, but more so the target that matters most to pharma companies. This is important because in the drug development stages it will lead you to an avoidance of disappointment in a later stage. Pharmaceutical companies care about the ability to gather appropriate patients faster than otherwise because having appropriate patients at an earlier stage, will enhance the success of clinical trials. This means convincing the pharma company that you picked a good target market, that’s worth going after. He drives it further by saying that a target can only be proven a good target when it becomes a credentialed one. Meaning that there needs to have been lots of academic work, testing and models done to be able to prove its credibility. The reason that this is so important is because there’s not enough credible data to train the algorithm, for example, lack of representation of minorities.
When it comes to the promotion of drugs he believes that the commercial way of doing it is extremely inefficient. He talks about the working day and how in an 8 hour day, only about 50 minutes is productive in making a sale or talking to a doctor.
“The way we sell drugs is primitive.”
The pharmaceutical industry is trying to find a way to get into the digital world of promoting drugs. The problem with this approach is that most doctors are not digitally inclined and don’t want to be bothered to learn a different way of doing things. He claims that whoever manages to find a way to get doctors on a digital platform and on board with limiting the face-to-face interaction of selling drugs – lots of money will be made. There needs to be an imaginative aspect to the solution to this process that isn’t too costly and too conventional.
“Good people want to work with other good people”
Making innovation happen in the biotech industry means you need to find someone who is the perfect middleman between a scientist and an innovator.
Stelios says that you as the leader, need to have 2 very important attributes:
If you love it, you can see it. Talent is going to recognize that and is going to want to work with you, just like in sports, where good players want to play on the same team as the good players. Top talent attracts top talent because they want to enhance their skills. Scaling this is a little more difficult. The challenge in creating a management team is identifying people like you if you’re a good leader that sees talent and finding people that share those same principles and mentality.
“Work with people who are not intimidated by talent.”
Stelios over the years has observed that consumers have become more sophisticated in the sense that they have more of an opinion on what the doctors prescribe. This is due to the internet. He has also observed and taken into account that consumers nowadays are bad at interpreting the information given to them on the internet due to the fact that there’s no one good site, available for credible information on drugs. This bodes to be true in a global sense.
In 1984 the US passed a legislation that created the legal framework for generic drugs. If a drug expired, then others were permitted to produce and manufacture that drug with no obligation to the original sponsor of the drug, financial or otherwise. The way people dealt with the new version of the drug was through analytical approaches, not on the basis of an extensive clinical study. This approach is what gave birth to the generics businesses.
“More than 90% of the business in the US is for generic drugs”
Stelios goes on to say when it comes to other bigger drugs involving more complicated molecules, we don’t have sufficient and reliable techniques to measure. The business of biosimilar drugs has taken off more aggressively in Europe. In order to get approval for a biosimilar, you need to do a clinical trial. It is a lengthy process because you’re essentially trying to convince people that it is a better and different molecule, but the changes are not harmful. In the world of biosimilars, there are biobetters. A biobetter molecule is like a biosimilar molecule, but more advanced. For example, if you need to take an IV infusion of an antibody every other week, a biobetter molecule can be created so that you can take the infusion every 6 months. In Stelios’s opinion the conundrum is if it’s meaningful enough to have a commercial interest, it’s probably almost as much as a cost and a burden for a new drug to develop.
Stelios believes that using real-world evidence gathered outside of the clinical trial setting, will happen and it will become very useful and important.
“Real-world data outside of clinical trial testing being used as primary or supporting evidence for files will become a significant tool in both regulatory and commercial points of view.”
He believes that what needs to be dealt with is the ability to make all sources of data clean and interactive and that you need to find an overarching approach to incorporate these data sets into something where you can extract meaningful results, and make sure they are properly curated. When asked which therapeutic areas can you attack first in terms of getting the best results and endpoints, Stelios mentions oncology and primary care. In oncology, he says that since there are smaller numbers of patients in typical cancer trials, you can manually curate the records. He thinks there’s more of an opportunity in the primary care space because there are more patients.
When talking about digital therapeutics, Stelios mentioned that there can be many advances in this industry, such as virtual reality games that are suitable to treat certain conditions. An example of this is more complex conditions such as autism. He believes it can be done with the right technology and research behind it. He mentions that digital therapy is cheaper but will still have a promotion in the efforts to sell it. The challenges can be on the commercial side and the business model, in terms of how you can make money off of it.