Why Big Pharma Feels Like A Financial Institution & Don't Pee on Medical Gloves with Anish Shindore

A medicine can be proven safe and effective, approved by regulators, and still fail the one test that matters: actually reaching patients in the real world. We sit down with Anish, a deep commercial thinker, to unpack what pharmaceutical commercialisation really is when you strip away the slogans and look at incentives, bottlenecks, and human behaviour. 

We start with our five value streams model of the pharmaceutical industry and use it to explore a provocative idea: modern big pharma often functions like a financial institution with extraordinary risk tolerance and time horizons. That framing changes how you think about R&D outsourcing, late stage development, pricing negotiations, market access, and the “programme management” required to bring a drug from molecule to monitored use. 

From there we move into the last mile of healthcare delivery: patient experience, physician capacity, restrictions on direct to consumer communication, and why “patient centricity” is hard in practice. We discuss remote care and digital health, including internet hospitals, plus the safety risks of self medication and the very real problem of adherence, from finishing a course to staying on track with GLP-1 medicines. If you care about pharma strategy, drug launch, market access, and what makes innovation stick, this one is for you. 

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Transcript

SPEAKER_01 0:00

Hello everyone and welcome to another episode of Lab2 Lives. Today we have a guest in the studio. And this guest is Anish. And the way that I got to know Anish was actually through a mutual friend who I bet is not actually listening to this podcast because he has no time with four kids. But if you were, then I can at least say that he made the right choice of introducing us because when Anish and I first met and had a quick call, I was like, whoa, this person knows so much and is a deep thinker. So I'm very happy to have you on the show. And you know stuff about stuff that I don't know that much about, which is the commercial part of Pharma. So very

Welcome Andorra And Basel Banter

SPEAKER_01 0:37

happy to have you here, Anish. Is there anything you want to add to that very uh descriptive introduction of you?

SPEAKER_03 0:42

No, we we're gonna make sure that that mutual friend of mine and we're gonna call out his name, Chapman, listens to this one because I'm pretty sure Ivana and I are gonna be sending him this video so that he can listen to it. Or maybe it's a bedtime story for the kids. So that's how we're gonna do it. But apart from that, really pleased to be over here. Calling in from Andorra, maybe not a lot of people know where this country is. A lot of people think it's a part of Spain. It is not, it's actually not even a part of the European Union. But if you like skiing, if you like cycling, this is the place to be. So I'm logging in from there. Look it up on Google Maps. And if you are here in town, there's a lot of stuff to do for 85,000 people. So please come on and let me know. Very cool. Especially Dimitri, right? You need to find people in LinkedIn Andorra, I guess. Surely I will.

SPEAKER_01 1:29

And of course, we also have Alex and Dimitri with us. Anything you want to say from your day or morning?

SPEAKER_00 1:35

Well, I was just gonna say Andorra sounds great. I'm turning 40 this year, so about to hit midlife crisis phase. So I can ski and cycle, you know, I can get the liker on or the the bodysuit and the cool shades. And yeah, that seems like good midlife crisis turtle for me. So maybe I'll do a move.

SPEAKER_01 1:50

That makes sense. Send pictures, please. Yeah, sure.

SPEAKER_02 1:53

Maybe we just record our next podcast episode in Andorra. We just need to bring the next guest as well in there and then we record or somewhere on the mountains.

SPEAKER_01 2:00

I mean, that sounds like a nice like lab to eyes off site situation. Could totally do that. Well, I would like to get us started with a check-in question. And incidentally, all four of us have something in common. All four of us have spent time in Basel in Switzerland. So I am curious to hear what is your favorite thing about Basel?

SPEAKER_03 2:19

You know, Basel is such a tiny place about from Roger Federer. I think there's very few things that stand out about Basel. But I do like the food in Basel. It's probably not the most famous things that you know about Basel. I guess the most famous is the dinosaur that is exhibited on the Novartis campus. But food I think is a is a good one. There's like cheese fondue places, Zermat, there's uh lilies, there's of course Walterbrau that is famous

Favourite Basel Memories

SPEAKER_03 2:46

for very different reasons for Novartis and Roche people. Yeah, yeah, food and food and food and drinking is nice. I like the scene.

SPEAKER_01 2:53

I used to travel to Basel every week for about five years. And one of my favorite things about Basel was I had like a running route along the Rhine, and I did it every day that I was there after work, which sometimes was like 10 pm. But sometimes when I dream, I still run like that exact same route in my head. So it's like if I ever was to build like a mental palace and place my passwords in it or something, they would be somewhere around the Rhine in Basel.

SPEAKER_00 3:19

People gotta swim in there, right? I've seen people swimming in the Rhine in Basel. Oh yeah. I actually had one of my favorite things about Basel. The first time I went there, the very first time I went there, it was in the middle of, and I can't remember what the festival's called, but this festival they have in September last night, where there's all of the big, lit up, very political exhibits being carried through the city that everyone's made of paper mashing, and then all of the basement beer bars are open and very cheap. That was a very intense introduction, but very fun introduction to Basel. So definitely one of my favorite things.

SPEAKER_02 3:53

The way you describe it sounds like when you're 40 you go to Andorra, but when you're 20, you should go to Basel. For me, I just remember the history of pharma museum extra. It was pretty cool well made, and I really liked. And when you go in the entrance, there's also this area with where you can buy stuff which is stylized as the old school alchemy-like pharmacies that they used to be in the past, and that's really I don't I really like this old old vibes uh from how things used to be, and that was just really nice, nice to explore. That's what I remember about Basel really. It's been a week for me there. Raclette was also very good, but I can't recommend any specific restaurant, unfortunately, for your next is the one.

SPEAKER_03 4:30

I have a list. I can send you guys one.

SPEAKER_01 4:33

Maybe it'll go in the show notes.

SPEAKER_02 4:35

Yeah, like not promote it.

SPEAKER_00 4:37

Well, I wonder if we should uh start creating some uh podcast laws, like laws of the podcast that we we discover. So number one is yeah, if you're in your 20s, go to Basel, if you're in your forties, go to Andorra. I think that's we've got the first one on the list there.

SPEAKER_02 4:50

Yeah.

SPEAKER_03 4:51

I'm gonna start asking for commission from Andorra Tourism on that.

SPEAKER_01 4:54

I like that. The first law of lab to lives.

SPEAKER_02 4:57

You know, it's always uh great to innovate in a new place where you like move somewhere where there's not so much pre-existed before, right? One of the things people speculate about Silicon Valley being successful is that it was far enough from the east coast of US, which was by that time very, very enriched with all the businesses and all the incumbents. So maybe uh you know Andorra can become a new center hub of pharma where all people move and they have already in their 40s, they have career, they have experience, they know what they're doing, they have the network, and then they just mingle over whatever is Andoran version of Raclette, and that's how the new great pharma is built up. I like it. I like it.

SPEAKER_01 5:34

That sounds good to me. And uh lots of cycling, bonding over cycling and hiking. All right. Well, then let's uh move into the first round of this podcast. I would be interested in hearing how we all place ourselves on the five key value streams in the pharmaceutical industry. And this is a totally Ivana-defined value stream model, and we may discover that it holds true, or we may discover that it makes no sense at all as time goes by. But for now, we assume that this is reality. I stipulate that there are five key value streams in our industry. One is the first one is the innovation one, where we answer the question does this drug or treatment work? We have the manufacturing

Five Pharma Value Streams Explained

SPEAKER_01 6:16

stream where we figure out whether we can actually produce this at the scale. We have the compliance stream where the question is can we prove the safety and efficacy of this product and the commercial stream? Can we sell and profit from the product that we have created? And then we have the corporate stream, which is about building an organization that can actually fulfill the promise of the product that we have created. So for this round, I would be curious to hear where everyone places themselves on this stream, and then we'll see what happens. Anish, do you want to go first?

SPEAKER_03 6:47

Yeah. For me, I guess my injection within pharma has been always on the commercial side. So that's that's where I sit quite, I wouldn't say very very comfortably, because that has changed quite a bit since I joined Pharma and the reason why I joined Pharma as well. But I I love the way you've defined your value streams, right, of pharma. I have a similar way that I've been defining for many years just to make sure that from a change management perspective, executives within pharma understand why they need to move like five years ahead rather than continue the legacy that they've been going. So I'm definitely with you on compliance, on manufacturing, the corporate piece, I call it pharma as a financial institution, because if you think about it, it is a financial institution. But then what you talk about innovation, I basically refer to RD on that piece. And then the last piece that that you look at from the compliance and regulation come hand in hand, but I would I usually keep it separate, but I'm completely aligned with you on the sales part of it, right? But if you look at pharma, and I wasn't in pharma 20 years ago, but this is what I heard pharma was, right? Pharma was an RD powerhouse, pharma used to manufacture, pharma used to take care of their own supply chain logistics, was a financial institution, and was looking into compliance and regulation. What has pharma become out of all of these five things? Are they doing RD? No, not that much. Very few companies are actually doing it exactly. And JPM is successful because of that, right? Because that's the center of getting all the molecules that you need in your pipeline. Second manufacturing is pharma manufacturing less and less every day, right? Because

What Big Pharma Still Owns

SPEAKER_03 8:24

you're looking into more outsource manufacturers on doing them. Supply and chain and logistics, definitely not. It's a critical part of the entire pharma ecosystem, and a lot of people don't give it that much importance, but it is like one of the pillars. So, what has pharma remained? It has remained a sales machine, a financial organization, and then a compliance and regulatory system. This is the perspective that people usually forget to have. Now, a financial institution, because there's a lot of requirements, even compliance requirements, that need to be met. But when you look at these three things, pharma as a commercialization machine, it's it's something that has not been challenged yet. There's no burning platform. Although profiles like Ivana, myself, and some others that we know, we know that this is not gonna last forever. And I think COVID during the pandemic, it was quite evident when you're not able to see people face to face, how this needs to evolve from what it has been. So definitely sitting very close to the commercial side of things, continuously thinking on as soon as you think commercial, you think about what roles people are gonna have. And this is not just pharma roles, because you've had sales like again, we talk about it as a sales machine, right? But you're talking about these salespeople talking to pharmacies, they're talking to healthcare professionals, they're talking to health systems, they're talking to government officials from a market access perspective. How does that need to get and I don't want to use the word that pharma calls innovation because that's really renovation today? Because what they keep on doing is they're keeping on doing small cycles of updates rather than actually sitting back and thinking, hey, is this the right way to do it? Can we actually now look into different ways of bringing the drug to market? And I I'll quote Paul Hudson at the summit at Davos that he mentioned on the panel that in EMA, in Europe, when EMA approves a certain drug, only about 20 to 25 percent, I may be quoting him wrong, maybe maximum I remember it was 40%, whatever is approved at EMA, that X percentage gets to the patient and it's a very low percentage. So there is something that is failing in this entire journey of how do you bring that drug to market if that's what you think about commercialization, right? So yeah, my time goes in looking into different ways of let that be direct-to-consumer, let that be finding different ways through health systems and insurers to bring that drug to the patient, because that's one of the things that we do quantify in an RD phase of a trial, because the patient and the drug become the center of the entire conversation. But as soon as the drug gets commercialized, then there are so many different actors and players that the patient and the molecule is probably the least looked at a combination in the whole thing. And and again, that's a bit provocative from my side, but if you think about it, how many of the people, how many people who are, and all of us potentially are on some kind of a medication today? Let that be cold and cough, Dimitri, for you. But how much of that is actually monitored so that there is going from prescription to actually discontinuation, you feel that you've been looked at or monitored. Not much, not much is what I see. So I don't know if another if that was your question, but I I tangent, I created a tangent for myself.

SPEAKER_01 11:38

I let's uh let's pursue the tangent. I find it first of all, I'm validated. Yay, five streams and uh some overlaps between the streams we have defined. Perhaps we're onto something ish. And then wow, you ask a very important question. What is a pharmaceutical company if it's not actually uh innovation?

SPEAKER_02 11:57

It is very interesting. Because there's like two things I can try to package it in my head, and I think they both kind of sound a little bit like what you said. So I'm wondering what you think. One is that pharma basically becomes a project group, like effectively a lean startup that outsource research to other companies that they acquire, they outsource production to the CROs, they outsource maybe one part of compliance and certification to CROs, and then they just manage the IP and connect the different teams. On the other hand, with the financial flows that you outlined, pharma is effectively becoming a VC fund because they have money, then they come to people who have some innovation, like startups, they acquire them kind of like VC would, or like give them money to finish the drug, and then they benefit from this drug going on the market. So it feels like pharma is going somewhere in between project management and VC rather than traditional research. Do you think that's kind of similar to what's happening?

SPEAKER_03 12:52

So let me maybe maybe first reflect on the financial aspect of it, right? I think the perspective that everyone has of pharma is cash. And I would define it a little bit differently. I would define it a little bit differently, and there's a reason. I think the appetite of risk that pharma has to put big money, sustain that for over 12 to 15 years, to wait and see if there is an ROI coming out of it. I think that's where pharma is good at. And there is a reason why I'm making that separation because not many VCs have, no, none of the VCs have the tolerance to wait 12 to 15 years in order to see a return. So financial institution, and I think we need to be, a lot of people do not understand that or do not, they know it, but do not internalize the fact that would you put your own money, would you put two billion dollars in a drug that potentially could not go out in the market? Would you wait by putting two to three billion dollars on something that may be challenged at the end of 12th year when you actually launch the product on what the pricing of it would be? No. So I would say from a cash risk tolerance perspective, that is the role that pharma is playing in order to make sure that they can sustain that level of risk financially. That's how I would put it, because I think a lot more credit needs to be given for that which is not given today. Then the other part of it, which you said, Dimitri, was in terms of project management. So, yeah, absolutely. I think there is part of project management, but projects come to an informal, drugs do not have an end-of-life timeline because it's not allowed by compliance to just pull off the drug. So I would even say there are different phases of the project that a pharmaceutical company manages, right? So there's of course the validation, right? From a compliance perspective, and thinking about completely commercially, right? Still, from a compliance perspective, no matter if they acquire the molecule, they create the molecule themselves, they have to make sure that it goes through that whole molecule to market kind of a thing. It goes through those different phases of testing that it needs to, which is marked by regulators before it gets to a point of can we launch this? What is the price at which we launched? And of course, they become negotiators at that point in time, right? They become, they create a function of procurement where they're negotiating what the pricing would be at a regional level, at a national level, and in countries like Spain and some others, Belgium as well, at a county or an autonomous community level. So they have to make sure that that part of the project is also done. Then once everyone is okay and we have a green light, then it comes to the launch of the drug itself. What exactly is the timing? What are the ways in which you're going to be launching it? Who do you need to connect in order to launch that? So a lot of times, and we know this, right? People talk about patient centricity, and a lot of times people spit out patient centricity without really understanding what that means today. Because there's a lot of regulation through which we cannot do direct to consumer, especially on the European side of the business, right? And there is also egos to play with. And again, I said I'll be provocative, but there's egos with physicians to play with, right?

Patient Experience And System Bottlenecks

SPEAKER_03 16:03

A lot of times what we've done is we've created campaigns for different, let's say, skin-related diseases. I won't specify because then the company will be quite obvious. But we've launched campaigns in order to create awareness, in order to build up the market so that people have a call to action and go and visit their their doctors. Doctors did not find that very amusing because they were like, you're increasing the volume of people that are coming to me. And that is not something that I'm expecting. And they're supposed to treat people. I I thought that's what doctors do. Yeah, but the issue is how many people do you treat, right? So in the public system, in Europe at least, you have a quota of patients that you are visiting, and that number is really high, really high. So the doctors could actually work 24-7 and they will still have more work to do, right? So how do you how do you manage those expectations as well? So that that has become I wouldn't call it a bottleneck, but the volume of doctors, physicians available today in order to treat the mass of patients that are there, that is not calibrated. That is not calibrated. And that's a big issue that most of the Western countries are facing, right? I mean, look at the EU-India deal. One of the deals is to bring talent. Now, what kind of talent? You'll start seeing a lot of doctors. That happened in the US, that happened in UK back in the day, right after World War II. So those things are about to happen over here as well in order to make sure that that gap can be filled because there's a much older population away. So that part of a phase of the project is very important. And how do you make sure that you have the right formula to bring this drug to the market at the right price? And then how do you then monitor it? How do you make sure that the doctor is aware that they need to look at a profile of patient? How do you make sure that there is a proper? Now the word comes in Spanish and I cannot say it in English, proper follow-up with the patient. And in a lot of cases, we when we talk about treatments, we don't never talk about discontinuation of that treatment. Although people drop out of treatments, right? So so how does that happen? How does that happen in a proper way so that if people need to be brought back on the treatment, there is enough history. So there are phases of which that pharma needs to make sure that is monitored well. So yeah, is it a project management thing? Yes, but there are there are it's almost like a huge program that you manage multiple projects, multiple phases within that. So it's it's it's quite a tough role, but at the same time, it's a much more defined, much more focused role than what it was in the past.

SPEAKER_02 18:31

So, like in terms of project management, what you're saying is fine to set correctly, it's kind of, as you say, it's much longer and also much more diverse projects than a single project team would normally handle. And in terms of investment, it's kind of neither VC, but also nor uh, let's say pension funds, because on one hand it's a very long money, which is closer to pension funds, but also very risky money, which is which is not close to pension funds at all, it's much closer to VC, but then VC would not tolerate 15 years. Absolutely.

SPEAKER_00 18:57

I think it's a bit that's interesting to dig into a little more actually. This is a change that uh I think uh I've also seen in the industry, but I don't know necessarily that it's filtered through into sort of everyone's awareness because if uh these large organizations are mostly starting to act as uh kind of late stage developers and financial institutions, that changes the way that we interact with them. And I mean we a little bit in terms of like smaller organizations on the side of developing drugs and things. So it would be interesting to understand your perception of what's driving this change in the in the big pharma folks and what they're trying to get out of it, because then that you know influences how all of the other actors in the space can can interact with this new model.

SPEAKER_03 19:41

Yeah. Which actually it needs to move as per how the regulators decide, how the policymakers decide. And I don't have a very good answer for it, but in my experience, and this actually, after I got out of pharma, I started working a lot more with policymakers and regulators, which in the past I used to completely mash it up and say, hey, you're a policymaker and regulator, and then soon you get humbled by saying those are very different people. And and and mostly they don't talk to each other, especially policymakers are very far away from reality on what exactly it is. I was at a conference some years back, a WHO conference. This was this was two years ago, and I remember some of the policymakers were still giving examples of how remote calls during COVID were so impactful, and they were showing numbers of we had 8,000 people doing this, and we had 16,000 people doing this, and I was like, guys, do you realize there's 400 million people in Europe? And you're giving us examples about they're really far away from reality or they have a delayed reality on things. I don't know which one is right, but they're not realizing that they're on a burner. So, how do how does pharma influence that? It has actually very less influence. It has very less influence, in my in my understanding. Where pharma has an influence on is potentially looking into some sort of a pricing model that can show a positive outcome that has succeeded on some therapies, not on all. Pharma has a little bit of leverage, I would say, in terms of existing reach of patients, where if there is an upgrade on therapy, right? So people move, for example, one of the exam one of the experiences that I had was within hypertension, there were there was a double molecule, double combination therapy, and people needed to be put on a triple combination therapy that was more efficacious. The marketplace was already there. So the only thing they had to do is infuse that, make sure there's no change in pricing, but make sure that people knew enough about the triple therapy, and that market was. So that's part of it pharma has good influence on as well. And then the third thing I would say, which is more on the RD side of things, you see most of the pharmaceutical companies, if you look at their pipeline, it's within immunology, within dermatology, within oncology, within urology. And within neurology, I would CNS, I would remove dementia and Alzheimer's because that's a very difficult disease to solve for. And a lot of people, a lot of companies have lost battles trying to figure that out. So so that's where they are working on. So that kind of defines for a lot of small, let's say, RD companies or data discovery, data-based molecule discovery companies to kind of focus on pathways that where they know that cash is going to be coming from. Apart from Novo, Lily, Roche, with this whole GLP1 movement that has happened, where they're now seeing impact on not just type 2 diabetes, but also obesity, where obesity is the market that is being more focused on because that's the cash cow. Diabetes has been running for the last 70 years. And yeah, people want an upgrade from insulins. They've had upgrades of insulins, but now they see huge impact. So now you see a lot of funds and a lot of research happening on GLP ones. I mean, but you had a dry period of diabetes where 20, 20, 30 years nobody was researching, with the exception of Novo, on how to cure diabetes. So I think those are signals for smaller companies to know where the pockets of money could be and where innovation could be driven. I would say that would be the best way to describe it, Alex, in terms of influence versus direction.

SPEAKER_01 23:39

I have this uh analogy in in my brain happening right now. Let's let's give it a go. If the pharmaceutical industry is a restaurant, then the pharmaceutical companies would be the owners of the restaurant. And the farmers who provide the food for the restaurant would maybe be like the biotechs and potentially universities. Uh the cooks in the kitchen would maybe be the CROs, the C DMOs, the regulators would be like the health inspectors or food critics, and then uh the restaurant clients would be the customers. So the owners, they they own the they own the whole thing. They they own the like production of the food, they own the marketing, the branding, the sales. They might not really know what's happening in the kitchen or or why people are unhappy. They might not even visit uh the kitchen very often, unless it's an Italian restaurant, then they're always uh in there ready to serve.

SPEAKER_02 24:29

So it's like a franchise restaurant, right? Where the owners have a lot of finance and they just open different sub-programs, i.e. sub-restaur, but they don't really go there themselves.

SPEAKER_00 24:38

Yeah, that that could be I mean, I think it's an interesting analogy. I mean, from the point of view of what it looks like is going on to me, not being as commercially involved as an issue course, is that you know, back 50 years ago, the pharma companies in this model were doing everything. They were raising the cows, they were, you know, taking them to the abattoirs, they were making the move the food and doing all of that and getting a meal out. But over time, what we see is that actually certain stages of that get much more expensive. So preparing the food, particularly proving that it's safe for people to eat in you know, the clinical trials and getting it approved and getting it out to people, that becomes exponentially more uh expensive and exponentially more complicated. And so actually they become much more specialized in this and sort of leave aside those earlier stage phases to focus on this kind of real specialized piece. And I think that's what drives the eventual outcome of that being the pharma companies essentially morphing into a financial institution, because they've got the money and the leverage and the and the expertise and connections to do this late stage really well, then they focus down on that. And and the rest of the pathway needs to be then filled by other innovative actors.

SPEAKER_03 25:49

I love the analogy. I think one of the things that is new and important within this whole, let's say, uh, zero mile agriculture to feeding the patient, uh feeding the customer is is what we've been what I think all of us have been working on recently, which is the experience, right? So the experience using the same analogy of the restaurant has been how do we get this Michelin star restaurant feed through a window rather than actually providing a proper experience for the patient in this entire game. That is the big problem that everybody knows about. Everybody knows that this needs to be sorted out and a lot of work has been done on it, but that hasn't gone at the pace nor has created that much impact today. That's one of the biggest issues that kind of is hovering over the entire ecosystem of pharma because you can you can call the people who are, for example, taking orders and serving food, are those doctors, or are the people who are sitting in the restaurant are those as customers are those doctors? We don't know. We don't know who the customer is today, right? Because we are trying to put innovation through the same funnel that has been used for the last 50-60 years. Or are we now opening the doors and saying, actually, the patient and their caregivers are the customers who are gonna sit on our table. The people who are serving are healthcare professionals who then talk to that window where orders are taken and things are given. That is not how most of the people will see how the industry works. They will see the doctor sitting and eating, not the not the patient. So I think that step, that A to B shift needs to happen at some point in time. It has already happened, I would say, in a lot of specifically in dermatology, if you see, it is going there in oncology as well, because now you have at-home chemo, for example, right? You see that in in New York, you see that in in London as well. It's it's specifically within metropolitans because the anxiety that is created for people, just sitting in that waiting room before their chemotherapy, it's insane. It it drives people nuts. So what they've done is they've started at-home chemos in in some of these places. So so now you're getting to a model within specific disease areas or specific therapeutic areas where patient is really patient experience is really something that has been worked on to eliminate other effects that they face just because being on a specific treatment. And I think that analogy needs to be expanded. And I and I love it to be honest with you, because we can fit into, I mean, nothing nothing against pharma and the restaurant industry. It's it's true, it's true, but the experience needs to come through. That's very, very important.

SPEAKER_02 28:34

I think it's very interesting because also we can expand it a little bit, and I think that's what you touched upon in your several times already, is that there is a it almost sounds like we're innovating faster than we as a society can receive this innovation. There is a cap at how many doctors, and uh I saw statistics somewhere in Denmark. I think an average person goes to their GP 10 times a year or something like that. And when I saw this number, it blew my mind because I go to GP like when I'm like like in these memes, I go to GP when I'm falling apart already and I cannot stand anymore. And apparently the doctors are overloaded, right? So they need to learn all these new innovations coming from pharma. When in before you had like a new drug every 20 years, now you have a new drug and seven conferences every couple of weeks. There's not enough doctors, there's not enough nurses, there's not enough anyone in the system. And with this analogy to continue on, what we are trying to do is that we're having restaurants with waiters, and the waiters are

Self Diagnosis Remote Care And Safety

SPEAKER_02 29:27

doctors, and we're trying to move to fast food where the doctors just shove things faster and faster. But the real way to make food surf very quick is a buffet, where the people just come and pick the food themselves and there is no intermediary between. And that's kind of also I think, especially with the development of internet, and I don't praise AI here, but I'm pretty sure with development of AI, people will go self-diagnose more and more, and they will just don't understand why they need an intermediary of a doctor to wait for two months to get an appointment just so that they can get a pill that they already know they should have, or at least they believe they know they should have. And that may create a big wave of pressure from the people. It's like it's like a queue in front of a restaurant that will push people to be like, okay, maybe we should try to fair a little bit more, because it seems like so many people want it, and that's just an interesting place to be in, I think.

SPEAKER_03 30:16

By the way, when you said that a lot of people from compliance are looking at this video, got a heart attack.

SPEAKER_02 30:21

No, no, but I think that's true, right? The thing happened with with people, just public thing that like I think just with the general with development of internet and everything, people started coming more opinionated. They come to doctors now like it was a shift in the last 20 years. Whereas in before you go to doctor, before Google, you go to doctor because you don't know what you're doing and you don't know why you're feeling bad. And now every second person who comes to a doctor already Googled then their symptoms and been like, I have this thing and it looks like it may be that thing. So there is just a general shift in perception how people shifted from seeing doctors as the eye-openers' oracles into more like checkpoint or on the way to health, isn't it?

SPEAKER_03 30:59

I think you're touching on something, but I'll tell you something that it is already invented. Europe, US do not need to invent this, right? So that whole self-service model, it's a very scary one because even normally people do not know how dosing works, okay? And and that is that that scares the hell out of me, to be honest with you, because people overdose, underdose, do not dose, they do all kinds of crazy stuff. So how much much power do you give to people in order to select their own medication or self-medicate? I have huge doubts about that. Huge doubts about that.

SPEAKER_01 31:33

It would have to be followed by like a democratization of medical information. Like all citizens will have to have a certain level of education in understanding their own bodies, their physiology, how medicine works.

SPEAKER_02 31:46

Exactly.

SPEAKER_01 31:47

We need like to add two more years of schooling to everyone to to be able to do this.

SPEAKER_02 31:51

But then you also have to adjust to the fact that people sometimes just don't really care about following the rules. They're just like, yeah, instructions, mistraction, whatever. I take the pill because that's what I should do. Bingo, bingo.

SPEAKER_00 32:01

I have a real example of this actually, because I did a bit of work for a while in eye drug delivery. And one of the main routes for delivering drugs to the eye are these kind of pre-filled seal pouches. But they're always for manufacturing reasons have a little bit of extra drug product in. So what people were doing were opening the pre-filled seal patch, delivering the drop, there's maybe 20% of the fluid still left in there, which they would then collect, you know, over several things in their own little jar and then use that as an additional dose. But the problem with that is that we have no idea what the degradation is, what the efficacy is after that point. And so while it seems like a sensible thing to do if you are just a normal person on the street, from a medical safety and efficacy point of view, it's not, sadly. So it's that's a big challenge.

SPEAKER_03 32:46

I may know the drug that you're talking about, by the way. And and after after this happened and people realized that doctors themselves, healthcare professionals themselves were while splitting, the company came out with a pre-filled syringe that once used, you cannot actually split the vial. And it was actually dose calculated for for making sure that the outcome happens, right? But what I did not mention is this does not need to be invented because if you look at China, for example, right? China has internet hospitals that have been existing for the last eight years. So it's a huge country. It's basically what you the GP part of it is done all remotely today. So a big part of China's population, I think, and don't don't hold me for the percentages. Clearly, you know, I'm not good at math and percentages, but a big part of China's population, I think 60 to 62 percent, live at the south coast, right? So Shanghai and all these places. But in mainland, there's still about 430 to 500 million people that live over there. These people, and let's say the most of the hospitals and most of the clinics are of course covering that south part of China, not the mainland part. So access to medication, it's almost like in Sweden, right? That someone is living on one island and they have to go to the other island to actually see a GP. So it has similar kinds of things. So China has already put in place, and you can search look this up, it's called internet hospitals, where the primary care bit of it is actually done remotely. So you have a physician that will look at you. They have different devices that they look at through which normal monitoring can be done. And and there's not much democratization of data, right? So they have access to most of the information of individuals, and through that, they are able to prescribe remotely what this individual is going to get. And and and that's it. So a big part of that volume in terms of medical qualified resources that are treating people with some sort of an illness is already done online. And in your case, Dimitri, right? Why do 10 people so why do people visit 10 times a year a GP? You need to you need to look into different age segments of people. How many how what percentage of uh Denmark is above 60, 65? A lot. The same like other European countries, right? And a lot of times, due to isolation, due to being alone, one of the biggest issues that the healthcare system is facing today is these people, the smallest of sneeze or the biggest of burps, however you want to put it, they have, they are like, I need to go and see a doctor, because that's the only place they are getting human-to-human interaction. So they keep on going for visits, even if it lasts for two, three minutes, just to make sure that everything is okay. And this is real, this is not made up. You can go to any center, GP center, and you'll see a lot more older people or with kids people with babies. That's the only segment of populations that you see. You do not see people within uh, I would say through through 45. Don't see that much. So I think that's one of the reasons, one of the let's say burning points also that we need to look into.

SPEAKER_01 35:51

One of my childhood friends is a a doctor in Russia, and he said that I forget the percentage. It was a surprisingly high percentage of ambulance house calls were made by elderly people who essentially just wanted a company because calling an ambulance, at least in in the city where he works, is freaking exactly. I was like, whoa, people would do that.

SPEAKER_03 36:12

Yeah, yeah. No, social isolation at after retirement is a big problem. And I'll I'll tell you one thing, right? So I was traveling to Copenhagen and after dinner I developed a rash over here all the way in Manek. You guys have an awesome service, by the way, because you can call and a GP attends you over a phone call. You send them pictures, they send you a text message, you upload pictures over there of what your rash is, they would recommend what prescription it is. You just need to make sure that uh your phone can receive those messages and things like that for roaming and things. But you can go with that prescription to a pharmacy and ask for that medication. All remote, tried and tested by me last year. So so it does work. It does work, but there is a segment of population that we would fall into that would be okay with that. You're not looking into uh people who've retired or elderly people to do that, right? So yeah.

SPEAKER_02 37:04

So I think coming back to our metaphor with the restaurants, I think there's two points. First one is that you know, we're not really in a restaurant, we are more like in the fancy, fancy Chinese restaurant where there's all these weird sauces and slugs and everything everywhere, and you just don't know which one you are supposed to eat and which one you do not, and and how much, and is this gonna burn your throat because it's so spicy or not? And you really need somebody to guide you, but at the same time, there are a lot of people in a restaurant who just don't care and just will put something on their plate and eat it. And that's this problem of delivery of last mile, if you please, of delivery of drugs. That we have we don't have like a mashed potato with meatballs, we have extremely complicated Michelin star level dishes where you're not even sure which part you're supposed to eat. And we need to somehow educate eight billion people on how to do that and make sure they follow these rules. And that's kind of this interesting, interesting challenge in terms of a restaurant. And then I had another idea, but I forgot it.

SPEAKER_03 38:02

Yeah, I don't know. What you say is true. What you say is true. It's a complex thing.

SPEAKER_00 38:07

Is how many of the topics are not about the science or the pharmaceutical or the regulatory end, really. It's about human and human system dynamics. You know, how are we able to position what we're developing and and these systems that already exist, right? These remote health systems, in a way that they're actually able to be taken up and used effectively by patients.

SPEAKER_03 38:33

The efficacy of the drug, we never question as a patient, right, that did it go through the right process. We would question that about food, even at a supermarket, even at a restaurant, on where the food came from and how exactly it was done. But we don't do that about medicines because since it's hit the market, we assume that it's gonna be okay. So that's one of the reasons why I think in this conversation at least, we haven't spoken that much about compliance and regulation because we are still talking about when the drug is approved and how it gets to people. So I think that's that's the interesting part. So it's it's almost like treat as treated as a hygiene factor that it's gone through the right processes and it's gone through the right things for you to actually take it. But the conversation, in my opinion, still remains about the individual or the individuals involved in in making that happen.

SPEAKER_02 39:24

Because I think actually that is I think it's just we are here a bit of a biased background crowd, and I think there is a bunch of people who will be like, This these drugs, these companies who make drugs, they're here to kill us. There is chips in the drugs, there there is poison in the drugs, you should not take drugs. So are people really not questioning drugs? I think they do. They just like maybe we are skeptical of their criticism of the drugs, but I think that there might be a very big pushback, like people coming to a restaurant and saying, Oh, like what is this food? Like, that's not what my ancestors ate, my ancestors ate the flask is thy with mesh, and that's what we're supposed to serve. And you know, there's been a big drama if what was it, halal food is supposed to be served in Danish kindergartens and schools or not? Because like it's a socially sensitive topic for the voters in Denmark, I guess. And that's kind of the thing, right? Like, so people discuss it about food and also talk about drugs.

SPEAKER_03 40:16

I guess there is some sort of a reality to everything, right? On those things, because there may be bias in terms of where our background comes from, there may be bias in terms of how exactly the system itself is functioning or not functioning. But at the same time, I think where there is more clarity on is there all there is always gonna be sick people, there is always gonna be some sort of requirement for treating those sick people. And yeah, the the fastest way we we are not about so in the past, what when you had a coffin cold, what would you say? Just drink a lot of water, tolerate it through the next four to five days, and that's about it. But again, I think we are in an age where when it comes to getting better, we want a quick solution for many reasons, right? Because we are working, we need to get back to office. Our child is sick, we cannot stay at home and take leave for more than two days. And the child needs to get fixed quite fast. So, what do you do? Use chemicals and you make sure that the medicine works and you follow that for one day, two days, and you incubate, make sure that it doesn't grow and off you go to school again as soon as you're a little bit better. So, in the end, yeah, is that a bias coming from us having a pharma perspective, or is that societal pressure that we are creating in order to actually have quick outcomes for certain things that we're dealing with? And I think it's a mix of both, uh to be honest. It's a fair question, Dimitri. It's a very fair question. And I think it's a mix of both because we are all a lot of un under pressure, and unless and until you have to take medical leave, sickness leave, most of the things you want to get done in the next couple of days and and that's it, and you're gonna go back to normal life. And that's unfortunate reality of what we are doing these days, right?

SPEAKER_02 42:10

That's quite bad actually. I think like just from societal pure societal standpoint. Why do we pressing people like we know it's not good for their health in the long run? Why why why is it happening? But but that's that's the thing we're having around us.

SPEAKER_01 42:21

One of my biggest fears is the anti-bacterial resistance. That is scary. And like back to the the dosing, like finishing your actual course of treatments is one of the uh reasons why we we have some of the problems. So it's it's like one one thing that health societies have tried to impose on us, like when you have a bacterial thing finish your entire course of treatment so they're dead.

SPEAKER_03 42:44

Uh you know, I had a big argument. I wouldn't call it a fight. My wife maybe she calls it a fight, but I had a big argument with my wife just last evening because she's supposed to carry a specific dosage that the doctor has prescribed for 10 days.

Adherence GLP1 And Behaviour Change

SPEAKER_03 42:58

She has to take that medication through. It's like a muscle relaxant because she she kind of had a c uh strained her muscle or the cervical area. And she was literally locked completely on Sunday. Monday morning we go there. The doctor said, You need some muscle relaxants. So plus, if you have pain, a lot of pain, have this medication. She hasn't been having a lot of pain, but the muscle relaxants are good. So yesterday I was like, Hey, have you taken your afternoon medication? And she's like, No, I'm just gonna take it twice because now I'm better. I was like, we need to stop telling ourselves that we know more than the doctor. And of course, that did not very fly very well with her. So, but that's that's a that's a simple example, right? Of how we kind of escape out of even taking medications. Yeah, it's it's a scary reality. I was like, just finish the course. It's a ten day thing. Maybe it will help you in the long run. Uh, you've just fixed it temporarily, but it still may be inside. Just take the ten day course and you're done. But yeah, now I need to buy our flowers.

SPEAKER_02 43:58

There's been this interesting article I read about. But it was just a news article about the GLP one we talked earlier with you and how people get off it, because it's not a thing that you want to take for the rest of your life, the idea that eventually you lost 15, 20, 30 kilograms, it helped you a lot, and then you get off it. And the article just talked us about stories of individuals who try to get off it, and some people just immediately jump back to their old weight, maybe five kilos less, and some people actually persisted. And it appeared to be that basically the differentiating factor there is that whether or not you want, whether or not you're willing to change your lifestyle and you're just using the drug as a kickstart, like you really try, but you can't. But with the drug you lose your appetite, so you actually can start living your new lifestyle and then you just stick with it afterwards, or if it's you're expecting a magical pill to work and then just be done with it and just keep living your old life, which brought you to where you are in the first place, where is it? And it's also kind of collateral to this idea of the last mile delivery of the drugs, right? And what's what you brought as an example. Do we just expect that this antibiotic gets me better in two days and then I keep living my life normally? Do I take my relaxance for two days and then as soon as I'm functioning, I just get back to my old lifestyle? Or if it's like a more okay, I'm actually quite much in pain with this thing, I want to change the way I'm sitting. I want a better chair, I want to sit less, I want a standing table, I want to move a lot, I want to do yoga every morning, and I will just use this my relaxance now because I'm just dying right now. And there's just two different attitudes.

SPEAKER_03 45:31

Absolutely. I can talk day and night about GLP1. So I've worked so much on those things. And I think people treat it as uh now we can call it a magical pill, I guess, but they don't realize uh how to lose weight in a healthy manner. Right. And that's one of the biggest issues that when you get that hockey stick kind of a thing, which is you lose weight and then all of a sudden you're like, okay, I'm at the weight that I always wanted to be. I'm gonna stop taking the medication and I'm gonna go back to what I used to do. Then goes the ho hockey stick up on the weight, and and people do not change their habits. So, what happens when you go and see a doctor? Any doctor for anything? They talk about take your medications, have a nutritious diet, exercise, and that's about it. These are the three things that they prescribe. The only thing that you monitor is actually if I'm taking the medication. The rest of the two, diet and exercise, nobody thinks about it. Nobody thinks about it, neither do they follow up. So so that's a big issue that people face by taking GLP ones. They think that the medicine is gonna kill my my hunger or is gonna kill my appetite, and that's about it. But then they they keep on cheating. They keep on cheating because they've trained their brain to get signals that this food is delicious. I need to eat, although the body is not asking for it. I mean, all of us we are crazy in some way or the other, right? We don't change our habits, we don't change our behaviors, and and that's what we I want to defend your wife here a little bit.

SPEAKER_02 46:59

I mean, I was the same with Physio, I was prescribed physio a few years ago, and I felt I can tell you my thinking because I realized at some moment I wasn't following it. Like I had a list of exercises, I still have it, I do it now systematically, but there was a period when I got it prescribed. I went to Physio every month, they checked in on me, how well I'm adhering, and I just realized I don't. And I was thinking why I don't. And for me, for example, my brand came up with a very good explanation. It said, oh, you know, it's just because it's not intense enough. Like you know how you work out at the gym, you know how you work out in your daily life. And these exercises are just like stretch like this for two minutes, your leg for 15 times. That's just how is it gonna help you? That's not gonna help you, just do something else instead. And on the surface, it sounded completely legit to my brain. So we just came up with this excuse. But I did it as well for for many months before it became a habit, and I needed to practice different practices of getting into habit that people advertise until until it actually stuck with me and until I actually got into this systematically, because some changes just can't be done with taking a pill for two days. But we really want to, with the pressure. We talked about it before, with the pressure of modern society. It's again, it's like a restaurant. You come to a restaurant, you want a cup of coffee, and then they're like, oh, we're gonna make the best coffee, it's gonna be like this coffee machine. Like, no, no, no, just pour me stuff and I have to run because my meeting starts in five minutes. Absolutely. No, that's true.

SPEAKER_01 48:21

It's like being a human being today is uh is a lot of work because it's not just existing, it's not enough. You have to maintain your body and your health because of our our longer lifespans.

SPEAKER_00 48:31

It's a job, just uh being alive. This closes the loop a little bit to the to the first point, which is if we want to step back and look about why maybe different parts of this process are specializing and why it is getting more complicated. Part of that also is that a lot of the low-hanging fruit is already done, right? And so we're getting into these more and more complicated problems that are more and more difficult to solve, more and more mitigated by things like, you know, patients' individual behaviors, for instance. And so, yeah, we're just in this much more complicated and difficult world right now, which is exciting, but also brings its own challenges.

SPEAKER_01 49:08

Absolutely. I have one more question that I gotta ask, Anish. So you mentioned that many drugs that already have been approved don't make it to the actual market.

SPEAKER_03 49:18

That's what Paul Hudson said. Yes.

SPEAKER_01 49:20

I was like, what? We're trying to get them out there.

SPEAKER_03 49:23

I'll I'll send it to you so that you can have it in the description. At Davos, one of the things on the panel when Paul was sitting with the presidents of different countries, one of the things that he mentioned was, and I started researching, I was like, how is that happening? And then of course I realized one of the drugs that I was responsible for in one of the companies that wasn't approved in one of the autonomous communities of Spain, and I was like, yeah,

Why Approval Does Not Mean Access

SPEAKER_03 49:48

I actually I actually know this one. So you have seven million people who never were prescribed this specific drug, although the rest of Spain was getting it. So how is that possible? And I'll I'll send you the video link of that. But there are many different reasons, right? There is one which is pure getting into price negotiations with the country and and and that doesn't happen. So you know you can see some drugs like Galvus, right, is not in Germany. It is available in other countries because they never reached an agreement on pricing on what it should be sold at. Is that fair now for an individual? I don't know. I don't know. But it's part it's what constitutes or it's what combines towards that drug being approved but not available for the individual itself. And I I feel it's unfair because and and that's where a lot of different routes open by which people do get to that drug, but now they cannot be monitored on it, right? And I think I think all of us know what I'm talking about, but that's that's how medicine then moves through different channels, and it's not a it's not a good one either, right? Yeah, that percentage is quite high, and I was shocked when Paul mentioned that at Davos, and I was like, wow, that's that's a really high number. But I can see, I can see why that is not happening.

SPEAKER_00 51:06

No, and the the same on the device side and and diagnostics as well. It becomes a big challenge because there's so many startups in the space as well, and there tends to be this idea that you know the the goal is the regulatory approval, the goal is your e-marking or your 510K or Deanova in the US. And that's it. Once you get there, you're you're you're done. But it's probably only about 50% of the journey. The other 50% is actually getting it into people's hands, which is it's what we were calling as hygiene factor, right?

SPEAKER_03 51:34

That it it has everything that is needed for this product to be safe, to be used or consumed. Now comes the real work of actually making it available in in the hands of people. Yeah, absolutely.

SPEAKER_00 51:45

Yeah, I actually uh yeah, I wrote down earlier when you were saying something, this idea that um safety and efficacy is necessary, but it's not sufficient.

SPEAKER_01 51:54

Yeah, yeah. All right, now that we're on the topic of devices, I would like to challenge the three of you to a quiz round. So today's quiz is centered around the question of where does this medical device go on the body. And I'm going to give you the name of the medical device, and I'm going to give you the three suggestions of where it could go. Then uh I'll uh hear your answers and tell you the right answer once you go ahead about. And you win the honor. And let's see if uh Alex, being the medical devices guy, if he has an unfair advantage on this one.

SPEAKER_00 52:31

I've got a makeup for

Medical Devices Where Do They Go

SPEAKER_00 52:32

last week where I got every single question wrong, so hopefully I can do better this time around.

SPEAKER_01 52:36

Okay, ready? Here we go. First question. Where does Ipsomate go? And your options are on the skin, in the mouth, or into the muscle. Upsomate. I actually know Ipsomate.

SPEAKER_00 52:50

But is it?

SPEAKER_02 52:51

None of the above. I like what Tiggs is trying to say is none of the above.

SPEAKER_00 52:55

Yeah, exactly. My understanding of Ipsumate is none of the above, but I'm gonna plump for uh into the muscle, as that feels like the closest option. So mouth, muscle, or what was the last option? Skin. No, actually, I'm gonna change to skin because I've just realized the mistake I've made.

SPEAKER_03 53:10

Yeah, I would say it's skin. Yeah, skin, skin.

SPEAKER_00 53:13

Dimitri.

SPEAKER_02 53:15

I really don't know, and it has a silly name, I would say. So I would go it goes in the mouth something, like you know, because why not?

SPEAKER_01 53:22

Very good. And also I will say that researching this did require more reading than I had uh anticipated.

SPEAKER_02 53:28

Why?

SPEAKER_01 53:30

Because you need to figure out like, so what is this treatment actually like? How does it work? I've watched demos. The answer to this one is on the skin.

SPEAKER_00 53:37

Yeah, well that's what's confusing, because it's it's into the skin, because it's a subcutaneous auto-conjector. You're right. It's my demo layer into the yeah. That's why I was confused.

SPEAKER_02 53:47

If what goes in the skin, it needs to be on the skin before it can penetrate the skin, right? So it's kind of technically on the skin.

SPEAKER_00 53:53

Well, but the the the the the the medical piece is the needle which penetrates.

SPEAKER_03 53:57

But it doesn't you don't you don't inject it in in the in the muscle, right? Because then it will be skin and muscle.

SPEAKER_00 54:05

Yeah, I don't think it's intramuscular, I think it's subcutaneous.

SPEAKER_03 54:07

Okay, okay.

SPEAKER_02 54:08

And do we know what it does? Like what which kind of drug devices is it?

SPEAKER_00 54:11

It's uh it's an auto injector, so it's uh a lot of drugs deliver better and more tolerable for patients if you deliver them into the skin as a as a bolus of fluid that sits there and then you get a like a time-release delivery essentially as it gets taken up. A lot of uh monoclonal antibodies do that nowadays and and things like this.

SPEAKER_01 54:29

Next one, where does netril go? And your options are into the skin, implanted, or into the muscle.

SPEAKER_03 54:37

Netril.

SPEAKER_01 54:38

Netril.

SPEAKER_03 54:38

Mouth into the skin on the body into the skin, implanted or into the muscle.

SPEAKER_00 54:45

I do not know this one at all, but I'm going to uh go for implanted.

SPEAKER_02 54:50

Yeah, no clue. I would pick the skin this time. Something like sounds like something natural, you know, like natural treatment, and that I feel something you would want to market if you're doing some dermatological stuff.

SPEAKER_03 55:02

Yeah, I don't know. Skin. Let's do skin.

SPEAKER_01 55:05

Very good. It is a breast implant.

SPEAKER_00 55:08

So it is implanted. Yeah, i the the name was giving me vibes of something to do with natural kind of a thing. Yeah, that kind of thing, right. Yeah. Okay.

SPEAKER_01 55:17

And this is another thing where I've actually learned something because I actually had not considered that, of course, anything you implant into your body is also a medical device.

SPEAKER_00 55:24

Yeah, I guess probably even class three, right? Class three. Most of it is class three, yeah.

SPEAKER_01 55:29

So I have learned. Good. Where does clear blue go? Into the skin, in the eye, or you pee on it.

SPEAKER_02 55:38

Eyes. I would say it's either eyes because you can see the sky blue clearly with your eyes, or it's a pee thing because if you pee and then it's clear blue, then you know you're healthy or something. And I will go with a pee actually because that's kind of a very memorable way of branding your device. Like if it's clear blue, you're like healthy and stuff, and you don't need to remember which color means what because it's literally in the name. There could be, yeah, sorry.

SPEAKER_00 56:02

My association here in clear blue is that I think it's a pregnancy test and it's called clear blue because it gives you a clear blue line of a yes or no.

SPEAKER_03 56:10

Well, those are red lines. But I yeah, I think I think you pee on it. This clear blue, I was thinking initially, or I'm I'm between still between eyes and and pink, but I thought the liquid that you put on your lenses, isn't that clear blue? It wouldn't be a medical device. Yeah, that's true. It's true. No, peeing test.

SPEAKER_00 56:30

Interestingly, I think lens cleaners, fluid, lens cleaners are regulated in some way. I think they do there's a I think there's a special exemption for them where they are regulated. Because the it's long-term contact in your eye, but just a side point.

SPEAKER_01 56:42

That is uh that is interesting. It is a pregnancy test. Oh, okay. So you do pee on it. But the marketing is interesting. This quiz is almost like a checkpoint on people's branding efforts.

SPEAKER_03 56:53

Yeah.

SPEAKER_01 56:54

Do they communicate what they're trying to say? I'm just happy I'm doing better than last time. And last time was uh Pokemon or a drug name.

SPEAKER_03 57:02

Oh wow. Or suck at both.

SPEAKER_01 57:05

Okay, next one. Where does microflex go? And I'll give you your three options. Does it go on your hands, in the eye, or on reproductive organs?

SPEAKER_03 57:15

It's a medical device.

SPEAKER_01 57:17

It is a medical device.

SPEAKER_02 57:18

I will go with the hand, like it helps you with tremor or something like that, because it microflexes your muscles in the right way.

SPEAKER_00 57:25

I was wondering whether it was gonna be a microneedle patch or something, but given that isn't one of the available answers, I guess not. I'll also go for the hand. Why not? Yeah, yeah, yeah.

SPEAKER_01 57:34

It is a medical glove.

SPEAKER_03 57:36

Oh wow.

SPEAKER_01 57:37

I did not know those were medical devices either.

SPEAKER_03 57:40

So microflex is a brand or is it It's the brand name of Oh, okay.

SPEAKER_02 57:45

So it's just a plastic glove that you put on your hand before touching the patient. The blue ones are the yeah. You can even say it's clear blue, Microflex. Wow.

SPEAKER_00 57:55

That might be confusing branding. Don't pin on your medical gloves, everybody. That's not a good idea.

SPEAKER_02 58:03

But you know, you can differentiate because you know how some languages have different words for the color blue, unlike English, depending on how blue it is. Like for example, Russian language is notoriously known for having light blue and blue as two different words for cultural reasons, I guess. Whereas in English you can't distinguish those two, which is why me and my girlfriend always fight whether the rainbow has six or seven colors. Because in my head, rainbow has light blue and blue as two separate colours. And I don't know what you guys are thinking.

SPEAKER_00 58:31

In the UK, it's blue and indigo.

SPEAKER_02 58:33

Indigo? Oh my god.

SPEAKER_00 58:35

Oh.

SPEAKER_02 58:36

Yeah. But there's purple in the end, right? After indigo, or is indigo the last one? Violet.

SPEAKER_00 58:40

Yeah, my fancy we call it violet instead. I don't know.

SPEAKER_01 58:43

There are two words in English then. Indigo.

SPEAKER_00 58:46

Yeah, but it's one of these like you're getting into real pantone colour territory here though. Like it's 127 because there's what like aquamarine coast or whatever.

SPEAKER_03 58:58

For me, Alex, those are because in India, when I grew up, that's the English. We learned the old English, right? So for us it was so obvious. I remember the first time when I went to the US and I used some word, and they were looking at me as like I'm sorry. What?

SPEAKER_00 59:14

I will also say I don't think I've ever heard anyone describe a colour as indigo unless they were specifically talking about the colours of the rainbow, because that's yeah, that's true.

SPEAKER_01 59:24

Okay, last question of the quiz, and we shall see who our champion is. Where does Unitron go in the transformer?

SPEAKER_02 59:32

Yeah, exactly. I was about to say it's a transformer. Sounds like it's Boston Dynamics robot who has a Chat GPT implanted in it, and he goes to Uni to study to prove that he can study like a real human, and his name is Unitron.

SPEAKER_03 59:46

Unitron and uh two one classification. I think I know I know this one, Ivana.

SPEAKER_01 59:52

Oh, you do?

SPEAKER_03 59:53

I think so.

SPEAKER_01 59:53

Does it go in the eye, in the ear, or into the skin?

SPEAKER_00 59:57

It's in the ear. I'm gonna cow it out of this one and give it an extra set into the ear.

SPEAKER_02 1:00:02

I will stick to my university metaphor. It's a hearing aid for people studying, so it's that's that's why it's called Unitron. Exactly.

SPEAKER_01 1:00:09

Well, it is in the ear, but I will say, like, they're so branded, the hearing aids. I was really trying to find someone that is one that uh wasn't as obvious as all the others.

SPEAKER_03 1:00:18

Yeah, this this one, because I remember just like four weeks ago we upgraded my dad's.

unknown 1:00:24

No.

SPEAKER_03 1:00:24

And this was Unitron. I was like, yeah, this is what I know.

SPEAKER_00 1:00:28

Too obvious.

SPEAKER_02 1:00:30

Yeah, yeah, yeah. That is a bit more of a transformer now.

SPEAKER_00 1:00:33

It's like, you know, new market opportunity, heaving aids that transform into little robots.

SPEAKER_01 1:00:37

I think that's can also do the dishes and stuff.

SPEAKER_00 1:00:42

Us living the dream, yeah.

SPEAKER_01 1:00:45

Well, I think you all did quite well. Thank you for humoring in my quiz. And to our listeners, you can also try this quiz and see how you would do. The link will be in the show notes. And we're gonna start rounding off. And I would like to ask for like one moment uh in this conversation where you're like, you know what, this was nice. Or this is a thing I learned that I did not know before, or this made me go, huh? I will start because I saw this question coming. And I will say that I'll pick a very like Ivana's ego-oriented one. Yeah, Anish, that you had a model that's very similar to the five ways that I've chosen to describe our industry that made me feel very happy and validated. And I was like, yes, we're on to something. We can solve this, we've got this.

SPEAKER_02 1:01:31

You know what it reminds me of, actually, if you know the Copenhagen

Key Takeaways And How To Connect

SPEAKER_02 1:01:34

map, the history behind the trains, the S trains specifically. If you look in a map, they look like a glove. And the idea was it was a hand model or glove model, I forgot, in the 70s, 1980s. And that was back in, you know, the times when we thought that everybody will live in the suburbs and commute 40 minutes every day by train or by car. So the idea was that we build trains instead of cars, and it's gonna look like a glove. It was five lines going in in a hand-like direction towards the different radials into the suburbs, and so we would commute to a closest station and then get to the city center. And in a sense, the idea is there is that if you live in Copenhagen, you kind of use those five lines to navigate, and all of them are accessible, and all of them you can use to navigate somewhere. And that's kind of like your five streams, where you also need to navigate all the five streams. You cannot just like shut down the line because that completely jams the tra uh the traffic. You need all five lines to be able to navigate where you want to go. Uh just like in farming, you need all five streams to to navigate.

SPEAKER_00 1:02:35

Like a glove.

SPEAKER_02 1:02:36

Like a glove. Like a glove.

SPEAKER_03 1:02:38

Alex, you have something.

SPEAKER_00 1:02:39

Yeah, the one I really like from this is the this reconf confirmation that putting the patient and the treatment environment front and center in what we're doing is not only great to do because that's what we're here for, but actually great to do from a business perspective. I think all of these issues around understanding how a patient's gonna use something, how they're gonna interact with it, what adherence decisions they are or aren't gonna make, you know, it ties all of these pieces together. That the more that we can understand and deliver to the needs of the patients in this healthcare context, then the better we're gonna do overall.

SPEAKER_02 1:03:15

For me, the most interesting part was, Anis, what you talked about, the transformation of pharma, so to say, or more rather the the current state of the farm and how it's different, that it is this very unique position of being in between kind of very long project management, sort of pension fund style, but also very big investment and also very risky investments, which is more like venture capital style. The two things that notoriously don't combine well together, high risk and long-term perspectives, and just how it is these days, how it how it looks, and talking about our also restaurant metaphor, which was another thing I really liked, because fundamentally we grew up thinking that every pharma drug, every device is effectively a highly complicated Michelin restaurant, but today we need to serve it differently. And basically the business you are in is that you go out in the market, you fund a Michelin chef with billions of dollars in a hope that they make a next breakthrough restaurant which will scale and everybody will go and enjoy the food there because they need to eat. But fundamentally it's a very risky, very saturated, very regulated market. And just this perception is very different, and something that I'm still curious that sparked this conversation in me is that how does this reflect on talents and talent acquisition? Because we are talking that even the pharma itself and regulatory bodies and uh the policymakers did not fully catch up with this new reality in which we find pharmaceuticals today. What about just general talents who want to go and work in these companies also, right? Are they still in their perception, thinking of pharma companies like this innovation, everything stuck together, production and RD companies, and how does this affect kind of people we get to attract in our industry? Because today the world is completely different, and maybe the global if if if customer perception, if patient perception didn't catch up with it, the talent perception also, that's something I kind of leaving this podcast with to think about. That was what I found very interesting.

SPEAKER_03 1:05:10

I think the the biggest takeaway for me, I think Alex reflected on that and and Limitree as well, on that human aspect of this conversation. Whenever we talk about health, we talk about people, we talk about emotions, we talk about things. I don't know how much of that resonates in day-to-day life. As we go in, as we literally peel the layers of the onion, in the end it's all about emotion and and human kind of a thing. And I don't know if the industry itself and and that's what I'm left, I'm kind of closing the conversation thinking is how do we actually inject a little bit of emotion within our conversations, within the time that we are spending with the doctor, even if it's for a certain period of time. How do we inject emotion when it's talking to someone that we care and love? about and how do we express that? Because that itself gives a little bit of validation, right? And that that feeling of having a safety net around you itself makes you feel a lot better most of the time. So how do you how do you make that more human-centric? So that that one of the things is my takeaway. It's not a response or a highlight for something, but it's something that I would love to implement in any conversation that I'm having. Now people may feel or find me foolish to always be so human-centric. That's fine. I don't care if they if they do that. But it's something that I would like to make sure that I inject in most of the conversations that I'm having, trying to make sure that health started off or healthcare started off by someone in the village being sick, someone who knew enough about science, checking their pulse and kind of not I wouldn't say diagnosing, but guiding on what potentially that path to recovery could be. That's where this industry started right and I think it's become super specialized, super complicated, but the human sense has slipped away which which is the sad reality of it. So I hope I hope to inject that at least in the conversations and the work that I do.

SPEAKER_01 1:07:10

That's an excellent takeaway. And if if our listeners have further questions for you I want to get in touch where can they find you?

SPEAKER_03 1:07:17

I can send I can I can share my email very openly with everyone. I can share my phone numbers very openly when you when you do that actually people are very conscious to message you because then they need to know what they're messaging about. But yeah, get in touch through LinkedIn through email don't send me messages on LinkedIn please please if you have my email just send me an email I'm much faster and much better at that because my LinkedIn is filled with software development houses trying to create apps for me which I don't really want. So so just send me an email I'm I'm quite quick at responding.

SPEAKER_01 1:07:47

We'll put them in the show notes. Well thank you everyone for having this conversation today. I had a lot of fun and I hope you did too.

SPEAKER_03 1:07:54

Thank you Ivana thank you Alex thank you Dimitri thank you so much