Pharmaceutical Market Europe • September 2024 • 12

DARWIN'S MEDICINE

BRIAN D SMITH
DARWIN’S MEDICINE 
SEEING GIRAFFES IN THE
BOARDROOM

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Why strategy sometimes needs a nudge

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It was very disconcerting. For a fraction of a second, as I sat in a plush, modern boardroom, there across the table from me sat a magnificent giraffe, slowly ruminating as its small horns and large pointed ears grazed the ceiling.

That this towering creature was wearing chinos and a polo shirt only made this hallucination all the more surreal. As my delusion faded, the even-toed ungulate in business casual dress resolved into a smart, serious-looking man who I knew as an executive director of medical affairs. Why had my mind created this fleeting little mental illusion? Read on for a few minutes and I will explain what seeing African fauna in a Swiss boardroom really means.

Flashbulb memories

I had experienced what Brown and Kulik called a flashbulb memory, the kind triggered by a surprising event. The context is important to this story, but I’ll disguise it because the details would make it extremely obvious which company and brand was involved, and that wouldn’t be ethical. We were discussing how the company’s very profitable first-in-class product was now facing severe competitive pressure from market followers and how we might respond. I was making the case for understanding the complex, contextual segmentation of the prescribing context, which was shaped by the needs of payers, patients and prescribers. The giraffe across the table from me was arguing instead for more detailed analysis of head-to-head outcome data, which so far had provided little hope. I asked him why he thought this data was the only place worth looking for competitive advantage. He replied, with a hint of exasperation: “Because that’s the way we do it in pharma!”, at which point he morphed momentarily into that giraffe in a polo shirt.

The giraffe’s nerve

Because I began working in pharma before my interlocutor was even born, I knew his assertion was right. Pharma and other life sciences business are, to a large degree, data management businesses. And when life sciences companies say data, they usually mean clinical data. Of course that’s especially true if you work in medical affairs.

So what he was really saying was that, as a pharma company, they had evolved to look for differentiation in the comparative clinical data. In this, they were just like most of their competitors. But why did that comment trigger my flashbulb memory of a ruminating giraffe? Well that’s because giraffes are famous for their recurrent laryngeal nerve, which takes a ridiculously indirect path of up to five metres to travel the short distance from the skull to the larynx. There’s no advantage in this evolved meander, it’s just ‘the way we do things in giraffes’. So my subconscious memory had made the link between his exasperated business assertion and this well-known biological quirk.

Baked-in choices

There’s an important, practical lesson in this parallel between biological and business evolution. Design flaws like the recurrent laryngeal nerve get ‘baked in’ to organisms and are impossible to change. But that doesn’t have to be true in organisations. Intelligent, open-minded executives can say: ‘What worked in the past won’t work in the future’ and consciously direct the evolutionary adaptation of their firms. In the case of this competitively threatened firm, that’s exactly what happened. In time, its executives recognised that, in a newly competitive market with payers calling the shots, relying on clinical differentiation alone would no longer work. Further, they came to realise their years of therapy area leadership meant they knew much more about the needs and motivations of payers, professional and patients than any of their competitors did. All that was needed was an internal process for extracting that tacit knowledge from the brains of their market-facing people, crystallising it into valuable insights and using those insights to drive their competitive strategy. Unlike the giraffe, they were able to redesign what evolution had left them with into something much more efficient and effective. I should add that the medical affairs executive, after his initial snappy reaction, was central in leading this adaptation.

Introspection

What lessons does this company’s experience hold for other companies? It teaches us to look out for implicit, unquestioned ways of doing things that were a good fit with yesterday’s market environment but now hold us back. Such introspection is never easy. It demands thoughtful reflection, an open mindset and some bravery. But in a market that is constantly changing, there’s no place for giraffes in the boardroom.


Professor Brian D Smith is a world-recognised authority on the evolution of the life sciences industry. He welcomes questions at brian.smith@pragmedic.com. This and earlier articles are available as video and podcast at www.pragmedic.com