The Strength in Heterogeneity of Purpose

OBSERVATIONS FROM RESEARCH-BASED PHARMA

I am fortunate to feel passionate about each aspect of my professional life, which has helped me understand how having a sense of purpose is key to enjoying and finding fulfillment in the long days, immense challenges, and difficult roadblocks I must navigate to be successful in my career.

In my vocation of drug development and commercialization, the commerce of health takes center stage. While among the most challenging professions, developing pharmaceuticals is also one of the most rewarding. Over the course of my career, I’ve had the opportunity to work toward admirable parallel goals: discovering and developing new medications that help humans in a way that few other discoveries do, and contributing to the operation of a successful business.

Passionate Science Followed by Passionate Selling

For the scientists working to discover and develop pharmaceuticals, a sense of purpose is palpable. These are the people working to translate basic science – the work that goes on to inform applied innovations – into tangible drugs, devices, and diagnostic tools. Clinical scientists achieve the same sense of euphoria when they successfully prove biochemical concepts in human testing, and then again when they establish that a drug’s effectiveness is greater than its side effects – meaning that it has therapeutic indications.

This amazing translational science is made possible in the pharmaceutical industry due in large part to effective marketing and sales tactics, which result in profits that can then be reinvested into research. Though different stakeholders may have different motives, everyone involved in drug development ultimately has the same goal. This is not to say that passionate scientists do not understand the need for a profitable business – they most certainly do. Likewise, those business leaders who are directly accountable
 to shareholders have an interest in developing solutions that address unmet medical needs and ultimately help patients. However, given the extremely low amount of drugs that make it through to approval (according 
to Reuters, about 1 in 10 make it from Phase I to approval), pharmaceutical companies must be cautious when it comes to the research they wish to fund and advance.

There is a polarity regarding purpose that underlies the desire pharmaceutical companies have for scientific breakthroughs (i.e. primarily the passion of scientists) and commercial blockbusters (i.e. primarily the passion of marketing and sales executives). This, however, is not a bad thing.

The Value in Heterogeneity of Purpose

While some might assume that these divergent purposes cause conflict within an organization, in reality, they 
are not so different. Janssen’s global head of R&D, Dr. Mathai Mammen, believes that such divergence contributes to a rich texture of various human viewpoints. “This heterogeneity of purpose of science and business in our sector adds a richness to a discussion that might not otherwise [take] place if everyone’s purpose [were] uniform,” notes Mammen.

For example, consider the development of drugs used to dilate the obstructed airways of patients with asthma or chronic obstructive pulmonary disease (COPD). Over the past several decades, scientists have improved these medications; while patients previously had to take them several times a day, scientists have altered the chemical structure of the drugs so that
 they now bind to receptors for a prolonged period of time, meaning patients need only take a single dose per day.

While these scientific advances have improved 
the lives of many patients, they have also resulted in increased sales and profits for the industry. However, 
if a scientist wanted to improve these drugs from once-a-day therapy to every-other-day therapy, it is unlikely that a pharmaceutical company would allocate funds to such a project. This is because the advance would provide little value to the patient, and it also would not benefit the healthcare system. While commercial decisions may sometimes override the application of good science, in this case, it would be in every stakeholder’s interest to focus their efforts elsewhere.

When might science and patient benefits overtake 
a narrowly focused view of simple profitability? What 
if price elasticity curves were discussed not in terms of maximal profits, but in terms of maximal patient benefit? Consider, for example, the recent game-changing advances in hepatitis C virus treatments. After decades of little to no progress, pharmaceutical scientists developed therapies with phenomenal attributes – the drugs are now easy to administer, require a relatively brief regimen of therapy, and have minimal side effects. The cost of these treatments is very high at $1000 USD per tablet; however, the new medicines have “a cure 
rate of over 95%,” as reported by the World Health Organization in 2016.

Heterogeneity Leads to Healthy Debates

This situation, in which science and business seem at odds with each other, prompts exactly the kind of healthy debate that can be brought about by divergent purposes. For example, although the medication is expensive, it could be argued that providing the medication to as many patients as possible is in the economic interest of the government, as its use would substantially reduce the burden of disease of the hepatitis C virus (e.g. it would reduce the number of liver transplants required). Still, the budgetary impact of these drugs on providers would require additional resources and innovative approaches to implementing this care.

Scientists will continue to discover and develop drugs that help humans; as long as they do, debates surrounding the commercial implications of marketing these drugs will lead to better care.

the author

Dr. Ted Witek

Dr. Ted Witek is a professor and senior fellow at the Institute of Health Policy, Management, and Evaluation (IHPME) at the Dalla Lana School of Public Health at the University of Toronto and Chief Scientific Officer at Innoviva in San Francisco. He is an advisor to the Design for Health program at OCAD University.