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As we get older, we definitely seem to get more reflective, and I certainly have been doing quite a bit of this of late!

As we get older, we definitely seem to get more reflective, and I certainly have been doing quite a bit of this of late! Some 20 years working within pharma world is a large chunk of anyones working life. Now out on my own, but always looking in, its sad to see the turmoil that now exists within companies and to think about the current and likely future state of the industry.

Their operating environment seems to be spinning out of control and it is not only in the banking industry where there has been a bit of a crunch. Overall, growth continues to decline and sales forces are being trimmed. Looking back, I have to reflect that if only companies had heeded some early warning signs, things might have been so very different. What wasted years!

I particularly recall the turbulence of major healthcare reforms here in the UK in the late 1980s, when the then Prime Minister, Mrs. Margaret Thatcher, attempted to introduce a new internal market for healthcare. The response of many companies at that time was negligible, despite the fact that these reforms, unlike any before, began to produce a whole new cadre of non-prescribing influencers. In fact, such changes were not just happening in the UK, as most western democracies began to affect changes to cope with the escalating costs of health care.

The company I was with then chose to completely ignore these changes, apparently hoping they would just go away. But they were, in fact, the very first signs that pharma world was set to face a very different world some 20 years in the future. I just had to jump ship and I moved to one of a small number of companies that had recognized the very beginning of these seismic changes that would echo down through the years to today.

The management of my new company was enlightened and recognized early that the industrys traditional prescribing customer base was beginning to change and they were prepared to invest resources to respond to that change. The company made a very bold move and in the early 1990s set up a pioneering sales and marketing team to address the new customers with original and innovative material aimed at partnering with the National Health Service (NHS) in order to deliver improved health gain for patients, as well as to drive up top-line sales.

Operations became much more customer focused and members of the new healthcare team were trained in a range of new skills, including account management and health economics. The growing new customer base was segmented from top to bottom and included health policy customers (both policy makers and policy takers).

Proactive and reactive policy responses were drafted for the major policy initiatives of the time. These intellectual offerings were adjusted according to customer type, and were related to health service delivery a prototype solutions-based approach. And I very much remember that other affiliate companies around the world were so interested in what we were doing that they came and visited. We also visited the Canadian affiliate to see if these ideas would transfer to its much more mixed market of state and insurance payers. They did!

One major UK policy stream at that time was the first stirrings of evidence-based medicine. A task force was set up specifically to respond, since the government of the day was beginning to introduce managed entry strategies for new technologies, based on the available evidence. This was all to try to control the diffusion of new health technologies into the NHS.

This was the very beginning of a major new focus by the NHS on the clinical and cost-effectiveness data supporting product claims. At the same time, there was much criticism that such data was often inaccessible to systematic review. So after talking extensively to these new kinds of customers, the company yet again pioneered the industrys first clinical trial register. And this was nearly twenty years ago!

Then sadly, this pioneering company went through a major merger and the usual corporate amnesia began to set in
Other companies thought all of these were rather silly and unnecessary moves and talked about the company responding too much, too soon. These same companies largely ignored the major changes happening in the environment and carried on with their usual knitting while high sales continued and the industry seemed so much in charge of its environment.

But fast forward nearly two decades and it seems as if very little has really changed. In 2009, there is a huge focus on account management within the industry. Companies are saying they are now more customer centric and are setting up market access teams to respond to the challenges of EBMs successor (health technology assessment), while critics of the industry continue to say that all clinical trials should be on national registries.. But it is all so Groundhog Day and Back to the Future. And actually everything has changed, and changed for the worst for the industry.

The Industry is no longer in charge and the power base has significantly shifted to the payers, who now have - very much - gotten their act together. The impact on the bottom line is palpable. And as a result, market access is now the biggest problem in many markets along with issues around how to deal with health technology assessment bodies such as NICE in the UK.

It seems after 20 years, it is only now that companies finally get it and are willing to adapt and change. But the industry journals here in the UK continue to lambaste the industry on this and that and say that this and that should be done. But the very same journals were saying exactly the same thing five, 10, 15 and 20 years ago. What a wasted two decades!

A popular bit of management jargon in the industry at the moment is walking the talk and readers will not need me to explain this. But just look again at all this renewed interest in account management. Everyone seems to be appointing Key Account Managers to deal with the new stakeholders and new influencers, but what I invariably see is simply rebadged representatives with the same kinds of old behaviors.

Lots of talking the talk, but still no walking Clearly, companies urgently need to talk the walk while walking the walk

With present pipelines apparently shifting to more specialist products, generalist primary care teams are being culled and secondary care teams beefed up. These are often the new key account managers, but with little real understanding of healthcare reform and payer needs. Many of these new products are, of course, cancer-related, but the very success of these oncology treatments is leading to cancer becoming much more of a long-term medical condition, with patients being maintained in the community - where there is now no longer any representative activity!

Healthcare systems, too, are trying to deliver more care out of hospitals, and it seems that they are moving in exactly the opposite direction of the industry. How customer-centric is that? And, of course, there is even more need today to speak to primary care-based organizations than ever over market access issues.

Again, managed entry is now a dominant driver in healthcare systems, which may, on occasion, advise that certain new treatments, although offering limited clinical benefits, would not be cost effective. That is to say, healthcare systems could achieve much greater health benefits by using resources in other ways. Regional and national payers are now much more informed health consumers and companies need to realize that there is no absolute right for new medicines to get onto the market; they have to compete with all the other forms of investment that healthcare systems have to make. Value and cost effectiveness are the new barriers to market access, with knock on effects right back down the line to phase II clinical studies.

So old behaviors must now be discarded and the talk really walked. There is that old maxim if it is not broken dont fix it. Well, the industry is indeed broken and now needs urgently to be fixed. All those wasted years.