Taking an Alternative Path
Medical Director for Ophthalmology & Neurology at Bayer, Jackie Napier, on what attracted her to pharma.
The transition from clinical practice to clinical development is not always an easy one for physicians who decide to enter the pharmaceutical industry. Having spent many years working directly with patients, making the move into the very different realm of industry can be challenging.
Jackie Napier readily admits she is a “little unusual”, in that she came into the pharmaceutical world at a much earlier stage than most physicians. Indeed, the Medical Director for Ophthalmology & Neurology at Bayer was still at university when she first became interested in a role as a pharmaceutical physician – still a rare breed in the early 1980s.
She explains to eyeforpharma that in medical school, she had the opportunity to apply for a scholarship which would allow her to do another degree in a year, while still studying medicine. Napier opted to study for a bachelor’s degree in pharmacology, a subject she said she found “fascinating” – and still clearly does.
If good doctors don’t go into the pharma industry then everyone is a loser, because you need physicians in industry to uphold the ethical and regulatory standards and be a voice for the patient. Some people think it’s still not quite the aspiration a young doctor or medical student should have, but I think it’s very important to get students interested at that stage.
A serendipitous invitation from a local pharmaceutical company for the pharmacology-studying medics was an epiphany for the young Napier; “For us it was just a break away from lectures, but we ended up having the most incredible day and I was totally blown away,” she explains, adding that one particular vignette from that day has stuck with her ever since.
“What really struck me was when they said, very often the first person who takes a new chemical entity, is the chemist who synthesized it. To my mind, that was pretty much the highest level of scientific endeavor – that you have so much faith in the potential of what you’ve created that you are willing to put literally your own life on the line. Of course, back then in the 1980s, there were far less regulations around early stage research than there are now.”
Napier calls it her “lightbulb moment”; “I thought, oh my goodness, this is what I want to do.”
“From then on, everything I did was aimed towards that, and I realized that in order to be a good pharmaceutical physician you have to have a solid background in clinical medicine because you are going to be living off that clinical experience forever more.”
You may be a pharmaceutical physician now, but you are a physician first and foremost. If you always in every decision you make put the interests of the patient first, you will by default be putting the long-term interests of the company and its shareholders first.
She agrees that for many medical graduates, entering industry is not a natural career path but believes firmly that it should be encouraged more in medical school.
“Medicine is such a varied career but often when people go into medicine they don’t realize the many niches that you can fulfil with a medical degree. If good doctors don’t go into the pharma industry then everyone is a loser, because you need physicians in industry to uphold the ethical and regulatory standards and be a voice for the patient. Some people think it’s still not quite the aspiration a young doctor or medical student should have, but I think it’s very important to get students interested at that stage.”
A physician first
Napier’s first role was with Schering Healthcare, working on clinical research into new cardiovascular products. “Schering was a perfect place to start. It was small-to-medium sized, very ethical and very supportive, and totally-family-orientated. I was very happy there.”
She tells an anecdote regarding an early piece of valuable advice. “Very early in my career, possibly my first week, my then boss called me into his office and said to me, ‘look you’ve got to remember, you may be a pharmaceutical physician now, but you are a physician first and foremost. If you always in every decision you make put the interests of the patient first, you will by default be putting the long-term interests of the company and its shareholders first’.”
During her clinical rotations, Napier had worked in neurology for a time and says she encountered many patients with MS. As a result, she was tasked with investigating a new MS therapy that had been developed for Schering, and eventually established the company’s first ever neurology research unit.
In 1994, she was made Head of Cardiovascular and CNS, later adding oncology and diagnostics to her portfolio, and essentially managed all the hospital products from a medical point of view until the early 2000s.
By then, however, Napier was the mother of two toddlers, and was offered the chance to reduce her responsibilities and switch to a part-time contract. She took the opportunity gladly, she says.
Another major change came when Bayer acquired Schering in 2007, but Napier is keen to stress that the changeover brought minimal disruption.
“Although Bayer is a larger company, it has a similar ethos in that it is very ethical in its approach and very patient-centric. It’s a company that I am enormously proud to work for. In 26 years of working in industry, I never once felt that I had been put in any difficult ethical situation.”
If clinical trials haven’t been performed ethically, or a marketing campaign hasn’t been carried out in line with the evidence, or there is a failure to report adverse events, these can have major business consequences, above and beyond the damage that could potentially be done to patients. You don’t win in the long-term by trying to buck the system, the rules are there for a reason and we forget that at our peril.
Indeed, there are many examples of instances where the industry has been found lacking in terms of maintaining and meeting ethical and regulatory standards – as Napier puts it, “we all read the newspapers”. The moral of the story is that it eventually does come back to bite them, and quite rightly so, she says.
“Some companies will suffer financially, and the way to prevent that is to always be ethical and to always put the patient first. If clinical trials haven’t been performed ethically, or a marketing campaign hasn’t been carried out in line with the evidence, or there is a failure to report adverse events, these can have major business consequences, above and beyond the damage that could potentially be done to patients. You don’t win in the long-term by trying to buck the system, the rules are there for a reason and we forget that at our peril.”
A growing field
It is only since 2002 that pharmaceutical medicine was officially recognized as a specialty in the UK. Napier was one of the first pharmaceutical physicians in the UK to become a fully accredited specialist. She explains that the field has since grown, and is now viewed alongside other, more traditional specialties.
The training curriculum involves a four-year program, which is mainly based on experience and work, although participants can also do external courses. Different modules cover the necessary aspects of working in industry, such as medicine regulation, clinical pharmacology, statistics, healthcare marketing, drug safety surveillance, and leadership skills.
While this training is not yet compulsory, Napier admits that increasingly, it is being expected by pharmaceutical companies. She adds that most reputable companies will support their junior medics to undertake this program of specialty training.
Changing the landscape
Napier has often married her clinical experience with her pharmaceutical nous and says one of her proudest achievements is her involvement in developing one of the first ever therapies for multiple sclerosis, a previously untreatable condition that saw young people confined to wheelchairs and given an early death sentence. She says she has seen the landscape of the disease change irrevocably, from her time as a young doctor.
“When I did my rotation in clinical neurology, I ended up chatting to lots of MS patients, and these were often young women because that’s the nature of the disease. They were a similar age to myself. They couldn’t process the news and they would ask if there was a treatment for MS which there wasn’t, and they would then ask if there was anything on the horizon and again, at that time, really there wasn’t. That is the hardest situation to be in as a doctor… I felt so awful about it.”
Developing these therapies for MS took many years and billions of pounds in research. Needless to say, the costs of the drugs are inevitably high and thus there are problems with regard to access in a new era of medicine rationing. Napier says the business of pharma is just that, but ultimately the patient should benefit from company investment in R&D. She also notes that access is a key issue, but adds that companies are more than aware of this and are engaged in a wide variety of efforts to ensure patients who need the therapies get them.
“The cost of developing drugs is enormous; of the drugs that enter development only a tiny proportion reach the market and a very high proportion of all the money we make gets ploughed back into R&D. Making money out of selling drugs isn’t a bad thing because the fact that one company makes money will attract other companies into the area to invest and ultimately the winner from all that is the patient. Our MS therapy was a great step forward but because Schering as a company did that, other companies also invested very heavily and now people with MS have a huge variety of treatments available. It may be difficult if the cost of a drug is high but I know that as an industry, we are very aware of it and we work hard to make our drugs available to patients because otherwise there is no point.”
Napier truly believes the pharmaceutical industry can be an enormous force for good.
“If you take something like organ transplantation, the actual mechanics of transplanting a kidney or a liver; the plumbing is very straightforward, what has made the difference in terms of patients surviving long-term following transplants are the drugs that are used. The anesthetics that allow people be anesthetized for long periods safely, the antivirals and antibiotics that help them fight off infection, the immunosuppressant that help them fight off rejection – that’s what has made them successful.”
The gender question
Despite women being in the majority within medical schools, they still remain under-represented in leadership positions and certain specialty areas within medicine. Similarly in industry, while women may make up the bulk of staff, when it comes to executive roles and the top jobs, these are invariably dominated by men.
The reality is that medicine is becoming increasingly feminized. Napier says that when she commenced medical school, roughly one-third of the students in her year were female. Fast forward 30 years and more than half of medical students are women. One reason for this may be the current requirement for exceptionally high grades in order to enter medicine, suggests Napier.
“Girls do better at exams than boys and I suspect that has got a lot to do with it.”
Napier doesn’t think the paucity of women in the upper echelons of management within pharma or medicine is necessarily due to a glass ceiling over both; rather she believes that the pull of family life can be too strong for women, and they tend to sacrifice promotion opportunities to top level positions that would negatively impact their already tenuous work-life balance. Her experience is that both companies she has worked for employ “a lot of women” but according to Napier, discrimination is not the main reason that women are under-represented at senior level in the pharma industry; “I think that is largely due to personal choice”.
Having been offered many senior or global roles that she herself turned down, she says she is not interested in further promotion, despite being more than qualified for it.
“I have got a very nice work-life balance – the company is extremely flexible and carrying out my role part-time is already hugely challenging. That said, if you do want the bigger roles, they are there and the pharmaceutical industry as a whole is very female-dominated. Our medical department is about 60 per cent female, and it’s up to 80 per cent in areas. I don’t think there are any barriers to progression, it is often just that women don’t wish to do so.”
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