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America’s Health Insurance Plans Institute 2007
June 20–22, 2007, Las Vegas
Artists from the past 150 years couldn’t have dreamed about the types of biologic drugs being turned out today. But pharmaceutical companies could stand to learn from two leading painters from those times, says writer Malcolm Gladwell.
“We are faced with extraordinary pressure to innovate in the next few years, but there’s a right and a wrong way to innovate. I worry very much that the national conversation is about to take the wrong path,” Gladwell, author of The Tipping Point and Blink, said at this year’s meeting of America’s Health Insurance Plans.
The right way, said Gladwell, is to follow the example of Paul Cézanne, rather than that of Cézanne’s celebrated follower, Pablo Picasso.
Picasso was about “conceptual innovation,” while Cézanne was more into “experimental innovation,” otherwise known as trial and error. Picasso’s career actually peaked early, while Cézanne built a reputation over many years.
“We’ve fallen in love with the notion that you can go in and understand a problem and fix it very quickly in that kind of Picasso-y way. But I don’t think that’s true of healthcare,” said Gladwell, whose books have made him somewhat of a darling in health-care technology circles.
The dynamics are too complex and there are too many stakeholders involved, Gladwell said. “We don’t need a Picasso to fix healthcare. We need a Cézanne. With really complex problems, you can’t always start with a grand theory.”
Gladwell told the crowd that healthcare reform ought to start with some experiments in care delivery. “Let’s also let consumers and industry choose which of those two routes they would like to go and see if we can construct it that way,” he suggested. “We might not get anywhere if we choose the direction in advance.”
This is particularly relevant to advanced pharmaceuticals.
“The last couple of years, big pharma has moved from Cézanne to Picasso,” he said. “It’s fallen in love with targeted drug design.”
The type of fishing expedition that produced blockbusters like sildenafil (Viagra) and atorvastatin (Lipitor) — originally developed to treat heart conditions and bacterial infections, respectively — may have gone by the wayside, to the detriment of innovation, Gladwell believes. “In most cases, we can’t figure out how something is going to work before we do that kind of investigation,” he argued.
“Now people are saying, ‘Wait a minute. We could have a theory about what we’re doing before we start. We can cut out the risk and the messiness. We can really efficiently, effectively, and cheaply come up with great new drugs.’”
But preconceived theories often don’t pan out, and some drugs have been rushed to market without adequate testing. The risk of another consumer scare necessitates more than just the willingness to fail, according to one specialty pharmacy veteran.
“What’s coming is a whole bunch of very specific drugs,” says Peter Smith, former CEO of Medmark, the Pittsburgh-based specialty pharmacy.
“Those need to be [supported by] a lot of diagnostic tests” that will target their patient populations. The new drugs will be expensive, but if used properly, might save payers and consumers considerable sums.
“I would be focused on making sure there was a test available to validate the usage,” says Smith, now a consultant in Lake Bluff, Ill.
“To me, a drug’s success depends on if it’s efficacious and whether I can prove that it’s efficacious.”