Why collaborating on a societal level is the new way to solve big problems in medicine
There is no better illustration of this fact than the success of the Innovative Medicines Initiative (IMI). The IMI is a public-private partnership that launched in 2008 with a bold premise - Pharmaceutical companies working together and with other stakeholders like academia, SMEs, regulators, patient groups and non-governmental organizations to remove bottlenecks in drug development. It is important to note that IMI-2 was recently launched.
The surprisingly adroit Mary Baker
Patients and patient organizations have a prominent role in the IMI, at least that is what the official line is.
A few weeks back I attended the IMI's patient engagement forum. It was chaired by Michel Goldman, the director of the IMI, and Mary Baker president of the European Brain Council and past member of the IMI's Scientific Board. I have to admit I half expected that Mary Baker would sit quietly by and make a few salient points only after being prompted.
After the first presenter, Mary spoke up asking a salient question and eloquently elucidating important aspects. She made the day much more interesting. So much so, that I asked if I could interview her. She agreed.
When you talk to Mary what first comes to light is that she has had a lot of experience in the European medical landscape. She started out advocating for Parkinson's disease as what she calls a 'fist pounding' advocate driven to increase the awareness and prominence of Parkinson's disease.
She must of had some success as she was then asked to sit on the European Medicines Administration's Board. An experience that began an evolution in her viewpoint. She was witness to what she describes as an unduly competitive environment. It was the consequence of a very "rivalorous society".
"Everything was resolved into silos." More importantly this was hindering drug development. "It is a bit like a hosepipe, you cannot get the water to the plants because of glitches."
Being a sociologist, this riled in her a sense of indignity. It was given further form when she began to work with Octavi Qunitana Trias. Like Mary, he also has a strong EU resume and has been the head of multiple different directorates at the EU and is currently the head of the European Research Area. Perhaps this speaks to why they both prosecute a similar mission.
Mary describes him as "very good team player" and as such he began to understand the frustrations of the industry. In contrast, patient advocacy groups at that time did not have a good understanding of the regulatory process. When a drug was withdrawn that patient advocacy groups would begin to pound their fists on the table because they did not understand why a given drug had to be withdrawn.
At one point, one pharmaceutical company self reported a problem with a particular drug they made and asked that it be withdrawn. It so happened that the company was asked to produce a letter jointly with a patient organization explaining the situation. The success of that effort in collaborative communication became a touchstone for what was to come.
Motivation for the IMI
The experience of baring witness to these events inspired what became the vision of the IMI. This was driven forward by Octavi Quintana Trias. The IMI was truly borne of out of the perception that in order to overcome regulatory hurdles both a better understanding of disease and a stronger collaborative effort was needed.
There was no doubt the approach had to be collaborative. No one person, institution or company could do it on their own. Trias himself put it best in a talk at the European Intersectoral Summit (EISRI) conference where he pointed out that "Science is not an issue of the scientists it is an issue of society." This is why in Horizon 2020 societal challenges are put in the forefront. Mary tells a good story that illustrates how this can be effective.
As a member of the IMI's scientific board she was treated as a full partner in the discussions. During one discussion doubts were raised about funding work on hospital acquired infections. There was uncertainty about whether it was worth pursuing scientifically. Mary spoke up. She told them that hospital acquired infections as a patient were something she were a major concern. The response was "Is that so?" The topic was not thrown out.
She points out "Money or lack thereof and an aging society has started to put such pressures on the system that it is right, ethically good, and proper to start to work together and to actually understand the 13 years it takes to bring a medicine to market. It is also important to understand that industry is not all about profit."
The idea of there being a sort of 'community chest' is one way that working together as society can provide enormous value. For example if one company has developed a potential therapeutic target but get stuck they could deposit it in a community chest. Until someone else figures out how to take it further. Both would work collaboratively to bring it to market. These are the kind of synergies the IMI enables through its funding of projects like eTRIKS, EMIF, and OpenPhacts.
"To recognize the value of competition and the value of working together was again something the IMI is really good at." Mary asserts that the IMI is the best initiative she has been involved with at the EU.
This focus on society and collaboration goes beyond research and development. When asked about patients and patient advocacy groups Mary is equally passionate about their need to evolve and work more together. No more fist pounding to get your disease recognized. You should no longer think of it as the 'patient perspective' but rather the 'societal view'.
What Mary is really talking about is a new type of leadership. In fact, in a recent Forbes post Mike Myatt clearly delineates the differences between what he calls the old paradigm of leadership and a new paradigm:
|Old Paradigm||New Paradigm|
|Have a Leader||Create a Culture of Leadership|
|Invest in Tools||Invest in People|
|Follow "Best Practices"||Develop "Next Practices"|
|Play the Game||Change the Game|
|Driven by Profit Agenda||Driven to Create Value|
|Discourage Independent Thinking||Embrace Dissenting Opinions|
|Start with "What"||Start with "Why"|
|Place People in Boxes||Free People from Boxes|
|Protect the Status Quo||Challenge Everything|
|Trivialize Youth||Give Youth a Seat at the Table|
|Reward Potential||Reward Contribution|
|Complex Decisions Controlled at Top||Complex Decisions Driven to Edges|
|Have a Plan||Have a Purpose|
|Leverage their People||Create Leverage for their People|
|Manage Risk||Manage Opportunity|
|Quick to Say "No"||Find a Way to Get to a "Yes"|
|Set Boundaries||Close Gaps|
|Destination Mentality||Continuum Mentality|
|Assign Blame||Accept Responsibility|
|Think Span of Control||Think Span of Awareness & Influence|
|Goal Driven||Discovery Driven|
|Focus on "Who" is Right||Focus on "What" is Right|
Competitive types will always lose
Mary's view on need for societal level collaboration fits nicely with the 'New Paradigm' of leadership. Jeffery Walker describes it as 'Collaborative Leadership' Walker goes as far as to say "there's no doubt that collaboration will be key to the future survival and success of humankind." A powerful statement. What if you believe that true competitors are the ones who win the most?
Well not all of it. Previous studies demonstrate that best solution to the prisoner's dilemma was to be selfish. The prisoner's dilemma is a scenario where two people are held separately by the police for a crime they committed. If neither of them talks they both will get prison time. If they both inform on each other they will do less time. If only one informs on the other that person will go free. In this scenario it always better to inform on your colleague. But what vital human activity does this scenario ignore?
Recently researchers at Michigan State University used computers to set up gaming scenarios where collaboration strategies were tested with 1000's of variations and iterations, with the inclusion of communication. The result?
Cooperation beats selfish behavior.
Communication is not just about speaking loud enough to be heard. Good effective communication is about saying what you truly think. Like Mary telling the scientific board that hospital acquired infection is an important topic for research, candor if often very effective.
The elephant in the room
Collaborating well requires an investment of effort. Effort in fully participating. Effort in establishing a maintaining structures that allow for impactful collaboration. Effort required in changing your mindset from that of a short term goal oriented competition driven approach to a long term collaboration driven approach. As Walker also points out "We still have a lot to learn about how to create long-lasting, cross- cutting, highly effective collaborations."
All too often collaborative projects are the 'weird' cousin of high value internal projects. You only deal with them as much as necessary, not more.
The elephant in the room is that until societal level collaboration is valued as much as internal projects, we can only dream of solving big societal challenges. Everyone needs to point out that elephant as much as possible. As it turns out, hunkering down in your competitive silos is not a winning strategy after all.
Solving societal challenges
If you want to help solve some of the big challenges in medicine, get in touch. We are focused on forming and managing consortia that involve multiple stakeholders and are not afraid to collaborate on a societal level. Just send an email: firstname.lastname@example.org or call +32 89 24 4009.