Episode 13 afterward: The biopharma glass is definitively more than half-full

Justin Steinman:
Definitively Speaking is a Definitive Healthcare Podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com.
Hello, and welcome to the latest episode of Definitively Speaking, the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, Chief Marketing Officer at Definitive Healthcare, and your host for this podcast.
Today, we have a special afterwards episode of Definitively Speaking. We haven't done one of these in a while, but Pam had so much to say in that last episode that we wanted to do a deeper dive here. So, I'm joined here today by my friend and co-host, Todd Bellemare, SVP of Strategic Solutions here at Definitive Healthcare, and by Robert Groebel, our VP of Global Life Science Strategy.
Robert's a new voice for our podcast, but he's a big thought leader and a regular on the speaking and publishing circuit. Most recently, Robert's been doing a bit of a deep dive into M&A in the biopharma industry, so I thought he'd be a perfect person to join Todd and me for this afterwards episode. Todd, great as always to have you with me.

Todd Bellemare:
Nice to see you as well.

Justin Steinman:
Yeah, we're all on the studio here today. Robert, let's dive right in. What struck you most about Pam's comments in that last episode?

Robert Groebel:
Well, it was a deep conversation that you had, but what struck me the most was the point of view that came from Pam, who is in the life sciences, but outside of the life sciences. She spoke very directly and frequently around the value of collaboration, the value of partnerships and the innovation that can come from them. What small pharma can learn from big pharma, how we can partner with academia to really drive innovation forward.

Justin Steinman:
What struck me was she kept saying a lot about under-utilization of academia. How did you interpret that?

Robert Groebel:
Well, I think that pharma doesn't know how to really partner effectively. I think that they've got concerns and questions about patent exclusivity and intellectual content and capital. There's an opportunity there, but it's waters that I don't think that they've tread very deeply into in the past.

Justin Steinman:
So, how could they?

Robert Groebel:
I think that they just have to be more open. They have to be more open, they have to use some of the strategies that they've always applied when they thought about building partnerships, but use it in a way that aligns their scientific mission to that of an academic institution or a group of academics.

Todd Bellemare:
I think one of the real interesting things that she said was how some of the time it takes to get these deals done, that academia could actually have more of a play there as well. That kind of made me think, when you think about niche contracts where you're trying to build those partnerships, relationships that all gets put on paper.
I think during the podcast, they talked about there's lawyers on staff and they're going to be doing this work, but sometimes the type of relationship they're working on can be so niche that the lawyer actually has to be a niche lawyer too. So, maybe that is an opportunity going forward for academia and pharma to actually have specific people that specialize in these types.
I'm sure they do. I mean, not saying that they don't do that and it's kind of a no-brainer, but we talk about how there's lots of new jobs coming out for this type of work. On the flip side to facilitate that work, there's lots of jobs there that could specialize in that.

Robert Groebel:
That's an eye-opening statement, I would've never thought of that. I think having that level of specialty that can safely bring a pharma company and an academic institution together as rapidly as possible, there is a downstream profit, there's a downstream value to doing that and having that level of specialization, I think that certainly would speed these partnerships.

Justin Steinman:
What do you think of the relationship though or the mission of the university? University exists first and foremost to educate. Correct? Right. So, how do they balance that mission to educate with, frankly, the pharma whose mission to make money?

Robert Groebel:
I'd like to take that mission statement with less of a black and white view. I do think pharma has the mission to drive patient outcomes, drive innovation and care, drive science forward. That's what we've always done. I think you can find a very aligned spot between academia, discovery, new science, new technology, and how pharma can apply that specifically to patient care and patient outcomes. I think that there's a natural fit there.

Todd Bellemare:
I think too though as you get into the dichotomy of what their missions might be, so academia, we all know that that is their main mission to educate, but to educate and to have some of the technology needed to help facilitate innovation, it costs money, right? So these types of engagements, partnerships, what have you, should be able to drive them towards better technology to then have better educational opportunities.

Robert Groebel:
Absolutely. I think at the heart of all of this, pharma has to continue to strive for trust. There's an inherent mistrust of what's happening to pharma. So to your point, make money, that's how people perceive the pharma industry. When you look at all of these smaller biopharm companies and biotech companies that are emerging across the landscape, they're there to drive science. I think they have the opportunity to help drive trust and drive partnerships, because inherently if we are trusting in a relationship, it's long-term and it will continue to bear fruit over that long-term.

Justin Steinman:
I think that's really interesting, Robert. I did say that, that pharma is to make money. We're all sitting here today vaccinated, yay, COVID vaccines, and yet the shareholders are punishing the stock price, because they're not selling enough of it. I think Moderna is now suing Pfizer and BioNTech. You're like, "Wait a second, hey, let's take a step back. We're kind of saving people's lives here, but it got lost in the swirl of commercialization and profit."

Todd Bellemare:
Yeah.

Robert Groebel:
Yeah, I mean, I think that there are companies out there, and I think Moderna was one of them, that didn't generate any profit off of their vaccine, whereas Pfizer, they didn't take any government money for it. What's happening with Moderna is they had made kind of an agreement going into this that they wouldn't be concerned with any infringement on their patents. But now that we're past that, they do have right to their own intellectual property and they should be partnering with Pfizer or partnering with other organizations as these R&D functions are creating other vaccines based on this platform. That's innovation.

Justin Steinman:
Does big pharma have a PR problem?

Robert Groebel:
I think they've always had a PR problem. I mean, come on. I remember all of my time in pharma, while it was marvelous and I learned a lot, I think that we were always running away from some interesting behaviors.

Todd Bellemare:
I think that you had mentioned the partnerships with academia, it's almost a give to get, right?

Robert Groebel:
Yeah.

Todd Bellemare:
So, if you see more pharma companies getting more trust by partnering with institutions to drive forward innovation and new either technology procedures or medicines, then maybe that's a way to take the edge off some of that PR. But you're right, there's always going to be a PR problem with spending money or having to pay so much money just to treat everybody with a certain [inaudible 00:07:16].

Robert Groebel:
Yeah, and I think if pharma recognizes the PR problem, they certainly have the machine behind them to address it. You look at somebody like a Novartis and they brought one of the earliest CAR-T therapies to the market, that therapy can only be delivered through about 32 institutions across the country. They're all academic institutions, so there is an established relationship, an established pattern there where they spent time developing, co-developing, training and really understanding where that patient population would receive the benefit from this therapy. So, there is an analog for this.

Justin Steinman:
So for our listeners out there, what is a CAR-T therapy, by the way?

Robert Groebel:
CAR-T therapy, it's a novel therapy where essentially your T cells are extracted from your bone marrow. They're then sent on to Novartis in this example where they're processed, and then they're transplanted back into the patient to cure their cancer.

Justin Steinman:
Wow.

Robert Groebel:
It's groundbreaking. You've seen a proliferation of CAR-T therapies coming from other big pharma companies and biotech companies out there. So this innovation, which is truly innovative, could cure cancer in our lifetime. I think that's a sign of hope, and that's a sign of partnership with pharma and academia and academics in general to develop these new and novel therapies.

Justin Steinman:
You've mentioned a number of times the big and the small pharma companies. What are the obligations that the big companies have to the small ones and the small ones have to the big ones?

Robert Groebel:
On paper, I don't know that there's any obligation.

Justin Steinman:
Right.

Robert Groebel:
Let's go back to the beginning, there's a competitive landscape out there. But if you think about the way that they could partner, and Pam certainly covered this in a number of her answers, big pharma's sophisticated. They have process, they understand how to fail fast, they understand how to execute a trial well. Are there ways that big and small pharma can partner together where small pharma may have the innovation, but big pharma has the capacity and they have the ability to commercialize something as rapidly as possible and get it into the hands of physicians and ultimately into patients?
I mean, I remember when I was still in pharma, this is a big pharma example, but at the organization I worked with, we recognized where our gaps were. We went and looked for a partner that could fill our gaps. So it's not that this behavior hasn't happened in the past, it was certainly much more commercially focused, but I think the same can be applied from an innovation and a discovery perspective.

Justin Steinman:
How did you find those partners? What are you looking for? What was the process like?

Robert Groebel:
Yeah, it was arduous, it was a real dance. I mean, it was a real dance to look ... you looked at the pluses and minuses. I mean, when we ultimately landed on our partner, we knew what we were giving up, but we also knew what we were getting. Oftentimes it's done similar to what you described, Todd, through an attorney, and they found someone who could bridge our organizations to bring the right outcomes to bear. Ultimately, the partnership that I was involved in was incredibly successful. There were pain points, but there were also celebrations that we had along the way.

Justin Steinman:
How did you define success? You said we had to give stuff up. So, what did you give up? What did you get and what made it successful?

Robert Groebel:
If the people who knew I was talking about them heard me say this, they'd probably roll over, but we had to give up and had to accept what we didn't know. We had owned this compound for many years, we held it very closely. It was a very personal thing to bring an innovative therapy to the market. But when we went into this partnership, we knew that we were partnering with this organization because they did things better than we did, and it's hard to kind of relinquish control.

Todd Bellemare:
So, you were a small company?

Robert Groebel:
No, we were a large company.

Todd Bellemare:
Okay.

Robert Groebel:
We were a large, but we were a specialized company and we needed partnerships that would help broaden our reach and our exposure into primary care. So, we needed someone who really understood the generalist landscape and it was something that we hadn't played within. There were certain subtleties to commercialization in that space that we had to accept feedback. You give up a lot on process and policy. There were things that my organization was very comfortable doing, but the partner organization wasn't, and so there are trade-offs. That's going to happen in research and development also.

Todd Bellemare:
I think it makes sense. Anytime any companies merge or there's some sort of partnership going on, there's a little bit of ego diversion that has to take place, right? That made me think a little bit about how the partnerships with the government might come into play. So, if DARPA comes up with some new technology that can be used in some medical setting, to then partner with them and have the government have to come in and say, "Here's what we're going to do left and right," it's a much different conversation than if you're a larger biotech or biopharma or pharma company that is going to a smaller one to say, "Hey, here's what we want to do. We know our people don't specialize that, but you do." But you have a little more leeway there than you might do with some of the governmental agencies and things-

Robert Groebel:
Oh yeah, I can't even imagine a governmental partnership. I think that's got to be ripe with challenges. I mean, if I come back to this partnership, I can remember, and I'll be dating myself, but Harry Potter was very popular at the time and there was someone that I worked with, that my wife finally said, "You can't come home and complain about this anymore, you've got to get over this." So, I started to refer to this person as Voldemort, this is the person.
Whether that's being a good partner, there were things that you just had to accept, that you weren't going to win every single battle and everybody at the heart of what we did I know had the patient in mind. Whether they were on the partner side, they were on our side, we were all ultimately driving to the same end.

Todd Bellemare:
Yeah, so that trust. The partnerships have to be built on some kind of trust. Even though there might be competing priorities, as long as you're driving towards that same goal.

Robert Groebel:
Well, I mean, it comes back to what you were saying about academia. You have to come into this with your best foot forward and create some level of shared mission where we're both driving towards the same end. Again, we might take different routes to get there, but collaboratively we're going to achieve the goal that we have, because there's a benefit for both, truly a benefit for both.

Justin Steinman:
It's interesting, because Todd introduced the idea of government and you had a pretty adverse reaction there, Robert, to working with the government. Yet, Pam who was in this very podcast studio a couple weeks ago was singing the praises of government partnership and talking about how Massachusetts, both Republican and Democrat governors, this is a big priority for the state and maybe that's just even best in class in this. So, let's dive a little bit deeper into your government reaction here.

Robert Groebel:
Well, my government reaction was probably more aligned to any kind of bureaucracy that would be applied to getting clinical research done and the mandate at the National Institute of Health or an entity like that. When you read what Pam was talking about or listen to what Pam was talking about, they're really looking to retain pharma in Massachusetts, and so there is a shared mission and a value in working with government to provide the most attractive case to stay in the state of Massachusetts.
I mean, if I think back to what Cambridge looked like 10 years ago and what it looks like today, it's fundamentally different. Pharma moved from Philadelphia to Massachusetts. I mean, Philly used to be kind of the hub, which it is becoming again. We're starting to see more and more organizations being attracted into the Philly area because of good government policies and attractive rationalization there. But again, my reaction was really related to this development or discovery or innovation partnership with the government. I think there could be some challenges there.

Todd Bellemare:
I think there's probably a big difference too, like you said, of a federal government versus a state government who might have a little bit more incentive to try to spur investment and businesses come to their state individually. So, something she had said about how there's a lot of movement of once you get past the drug discovery and development piece to manufacturing tends to get down to North Carolina or Maryland or move out.
I do know anecdotally, I have a friend who's an architect that specializes in building labs and biotech buildings and the business has been booming for the last seven or eight years. It's just always a project always going on from Connecticut to Maine, up and down. So, I think that some of those Massachusetts-based government projects have certainly helped keep things at least in the New England area. So, it definitely is interesting from a-

Robert Groebel:
Well, it's actually interesting as we dig into this a little bit further, we're initially talking about this from a revenue perspective, from a tax-based perspective, but think about what you see in the news all the time, healthcare disparities. Are there areas of the country where you have a prevalence of a disease and an underserved population, should that state level government be looking for partnerships in a particular disease state to bring that innovation into their state where trials can be done and therapy can be provided as part of that partnership agreement? I think that there could be something said for that if you start looking at it from a disparity perspective.

Justin Steinman:
But you don't need to move the company there, right? The government should be starting the company, just [inaudible 00:16:31]

Robert Groebel:
No, I think you have to have concerted activity there. It's not a brick and mortar thing, it's how much of your pharma resources will you impart within this community or within this state to bring your trial data forward to create, to manufacture, to look at a subpopulation to bring care to that group.

Todd Bellemare:
Even partner with tax incentives to partner with academic institutions in a state that has higher disparities of care.

Robert Groebel:
Yeah. Yeah, yeah.

Justin Steinman:
It starts to feel like you need to get the public and the private and the academia and the venture capitalists and the private equity. Almost like the investors, the inventors, the government, the bureaucracy, if you have it, and the academics all kind of working together to build this ecosystem. If any one leg kind of falls apart, the whole thing kind of tumbles.

Robert Groebel:
Yeah, I mean, I think it would be an interesting level of analysis to start to bring actually just a third party. Bring this data back into pharma to say, did you realize that in the state of Alabama or in Northern California there's an opportunity that aligns with your phase two pipeline? See if there's a reason to engage in that government discussion, in the academic discussion, et cetera, et cetera, to build a different type of partnership.

Justin Steinman:
Let's pivot a little bit. One of the things Pam also talked about, and I'd love to get your insights on Robert, is commercial models are evolving and changing in the life sciences. I know you talk to a lot of customers, a lot of different people every day. How are commercial models changing in life sciences?

Robert Groebel:
Oh, I mean, there's so much change that's going on from a commercial perspective. At the heart of it is the impact that the Affordable Care Act had on our business 12 years ago, and looking at the types of innovation that are coming to the market and the types of diseases that we're studying. We've moved out of the Me Too world and population health and we're focused on rare disease.
I think looking at the complexity of these interventions requires a different conversation, it requires engagement in a different way. You see organizations trying to understand a patient journey, but also trying to understand a care team. So if you think about how cancer care is delivered, it's not by an individual, but it's by a group, and so you have to think about an engagement model that aligns your organization to a care team so that everyone in that decision-making process has the same level of information.
I think you've also seen, precipitous is probably too strong of a word, but you've seen a shift in firewalls. You've seen collaboration really come back between medical and commercial organizations, because they're working on a shared goal in a very rare space where the work that your medical team does drives true awareness and mitigates uncertainties, and answers all of the complex questions that are associated with these new drugs, so that as the commercial team has a conversation around reimbursement and coverage, it makes things that much easier. I think your medical organization has become far more strategic than we've seen in the past.

Todd Bellemare:
The start of what you were talking about in terms of understanding the patient journey and the care teams, it kind of made me think about when she said everything is data in the end. So when you think about the strategies that those commercial teams are using now, they are built around data, and so that's why she said ... I forget if it was you or her who said it's a great time to be a data scientist, and that has never been true more than it is right now.
So when I think about identifying care teams and who would use that information, it really goes across the spectrum of the different pieces of the commercial team that are there, and you use data analytics to pull that out. Whether it's looking at genetic testing data results to analyzing claims data to pull out the right people who are working on the right patient at the right time, to then allowing that to inform you where you're going to put your phase two trial. Where are those patients that have those health disparities, A, B, who have the disease that you're working your clinical trial towards, and then who has an adequate care team involved in those academic, or even if it's just any other institution.
So, it's been interesting from my side from a data analytic perspective on the people we talk to now versus who we talked to five to 10 years ago or so.

Robert Groebel:
Yeah, it's funny you say that. I mean, I did make a note on the transcript around a good time to be a data scientist. If you come back to the concept of academia, is pharma making their data available to data scientists, people that have been steeped in this for years and years and years to do some level of analysis. I think there's an opportunity there, but yeah, I agree with you. We've seen such growth in the number of data analysts that we're engaging with, pharma big and small.
When you're thinking about, let's use the Novartis CAR-T therapy again. They've applied at-risk contracting for this, the patient has to respond or there is no reimbursement for it. So an organization really wants to be certain that through data and analytics, they're putting that intervention in the absolute right responding patient. That's not a subjective choice, that's a data-driven choice.

Todd Bellemare:
Right. It's the melding of the clinical data. So, mining that genetic testing information to build panels of the right patient that will respond to the right treatment, to then tying that back to people who actually have the disease and also got the test that matched that panel of comorbidities or genetic markers that will respond correctly.

Robert Groebel:
Yeah, I mean, I think companion diagnostics, it's such an interesting and exciting field. I mean, if you can align a successful intervention with your own genes, it's amazing.

Todd Bellemare:
Yep.

Robert Groebel:
It's just amazing.

Todd Bellemare:
Perfect combination.

Justin Steinman:
So Todd, you said you're talking to different people today than you were five years ago. Who were you talking to five years ago and who are you talking to today?

Todd Bellemare:
So a long time ago, we were just talking to account execs who were managing the sales teams that were basically telling a pharma sales rep where to go and who to talk to. So, the level of complexity let's say seven years ago, whatever it was, "Hey, just give me a list of doctors and the percentage of the total volume they're treating in their area." Great. I'm going to sort that top to bottom on an Excel sheet and I'm good to go. That's all the data I need.
So now we're talking to those people still, they're asking much more sophisticated questions than they were seven years ago. Now it's I don't really care about the overall volume, I want to know who they're connected to and what that care team looks like, so if I can't talk to that one doctor, who's connected to that doctor to be able to maybe help spread that influence over time?
So, those people are still in the mix asking more sophisticated questions. We're getting [inaudible 00:23:11] teams, who while they are firewalled from certain data, they're asking ancillary questions around the data about maybe not exact volumes, but just therapeutic areas by certain people maybe who have done speaking engagements in the past and they're getting more details there.
They're not even just asking for volumes of publications, they're trying to get scores. So, how can I score people X, Y, and Z? So med device, the actual sales people themselves, the account execs at home, and then we have ... at the home office, excuse me, not at their homes. Oh, maybe they're working at home. The folks at the home office are coming up with a strategy on what to do with their drug. Maybe it's coming off patent, what is my strategy going to be from here? I'm going to use data analytics to try to solve that problem.

Justin Steinman:
It's a whole new level of sophistication it sounds like.

Todd Bellemare:
On multiple levels. Yeah, for multiple groups and multiple levels.

Justin Steinman:
So Robert, I want to come back. We've talked a lot about around, but really haven't talked about the role of the patient and the caregiver in all of this. What's your perspective?

Robert Groebel:
Well, if you look at the role of the patient and the caregiver today, it's fundamentally changed from a discovery and a drug development perspective. Their voice is represented in regulatory bodies, you see patients and caregivers actively involved at scientific societies and presenting and ensuring that pharma understands the impact.
I think that there is a real demand that has been recognized for innovation, and I think patients have taken their own care into their own hands, caregivers taken care into their own hands. I think the industry has to continue to recognize that this is a very strong voice and they are looking for interventions that not only address symptoms, but are addressing diseases that have really an unmet outcome right now.

Justin Steinman:
So Robert, you've struck a very optimistic tone here today. For that, I love it, right? I'm always a glass half full guy.

Robert Groebel:
Yeah, me too.

Justin Steinman:
Right? So, as we're looking at where life sciences are changing, you talked about curing cancer 10 minutes ago. My jaw but hit the floor, that seems like one of those incurable things. Are you generally optimistic around the outlook on cures and where we're going? How different are things going to look in 10, 15 years?

Robert Groebel:
Oh, you know what? I'm really optimistic, and I think that I've never seen this level of innovation and partnership that we've seen in the last five or so years. I'm not the first one to say we're going to cure cancer in your lifetime. That thought is out there, it is pervasive, and there are therapies that do cure certain kinds of cancers. You've seen life expectancies change, you've seen amazing improvements in therapy for tumors that before had really little hope of any kind of substantive response.
I think that pharma certainly has evolved and they really are driving missions that have changed, because oftentimes the missions, we're talking about management, we're talking about outcomes nowadays. You see organizations divest areas where they don't have the right expertise to focus on pipelines that they're really committed to. I think pharma recognizes that they've got a voice and it is my hope that there's a level of trust that continues to grow, there's partnerships that continue to evolve and the innovation continues to drive.
I mean, there are so many other diseases out there that really have little hope. I mean, I have a personal experience with Lewy body syndrome. I mean, this is a really tremendous disease and there are organizations working on this, working on innovations that will give people hope into the future, and I think that makes me positive about pharma.

Justin Steinman:
That's really optimistic to hear.

Todd Bellemare:
It is. I am the glass is in the middle type of person. I mean, I take that back. I am optimistic about a number of different things in terms of the speed of which technology is changing and making things more accessible, and just the leaps and bounds we're growing at in terms of what we're learning, like CAR-T therapy. All the new innovations that are coming out, I'm very hopeful in those sorts of things.
I do think that the way we treat healthcare as a supply and demand problem, which we've talked about quite a bit over the course of this podcast. But I think that while I'm all for a capitalist society as we sort of see it, there needs to be some adjustment in how we treat healthcare, because you can't really price healthcare or CAR-T therapy like it's a bottle of milk on a shelf, right? If there's not enough people to buy that milk, it's going to go sky high. There has to be some kind of regulatory or a regulated capitalism around healthcare, which there is to an extent, that is maybe a few standard deviations above where we are right now.

Robert Groebel:
Yeah, I don't disagree with you and I share your sentiment. I think we should have greater equity in healthcare and greater access and opportunities, and it shouldn't be a one-size-fits-all. Healthcare innovation should reflect the patient and reflect the patient's ability to consume that healthcare, pay for that healthcare, enjoy that healthcare.
The other thing you can look at though is, as pharma has continued to develop, are all of the subpopulations they continue to look at. They are addressing healthcare inequities and trying to do this and making clinical trials more inclusive to reflect a more diverse patient population, so there are elements out there that I think that are making their way into the day-to-day work that pharma does.

Todd Bellemare:
So, that's what I'd say I'm probably optimistic about as well. In addition to the technology increasing and doing better, but there has been a much more concerted effort by biotech, biopharma, pharma in trying to address some of those inequities that happened over the course of the last 100 years or so.

Justin Steinman:
Well, I think on that note, I like to end on a positive note, have our listeners walk away feeling good about where they are, so I think we're going to kind of stop here. Guys, thanks for taking the time to talk with me, this is really interesting.

Todd Bellemare:
Thank you.

Robert Groebel:
No, thanks very much. Appreciate it.

Justin Steinman:
For all our listeners out there, thanks as always for joining us on Definitively Speaking, a Definitive Healthcare Podcast. Please join me next time with a conversation with Beth Holmes from Hint Health, a provider of technology for direct primary care.
If you like what you've heard today, please remember to rate, review and subscribe to the show on Apple Podcasts, Google Podcasts, Spotify, or wherever you get your podcasts. To learn more about how healthcare commercial intelligence can support your business, please follow us on Twitter @definitivehc or visit us at definitivehc.com. Until next time, take care, please stay healthy and please be optimistic.