Unsurprisingly, for a researcher focused on the evolution of our industry, most of what I write is about change. And, as I wrote this column for publication in January 2024, I reflected on what I’d written in 2023 and whether there were any useful themes that might be relevant to the New Year. It turns out there are two, so stay with me while I share those with you.

There’s an old saying that if you think change is easy, then you’re doing it wrong. Indeed, four of my ten Darwin’s Medicine columns in 2023 were about how difficult change is. ‘Declining Disruption’, for example, reported new findings in a Nature paper about how pharmaceutical patents are becoming less disruptive over time. Another one, ‘Being the Change’, was about the futility of US pharma companies trying to fight the enforced price negotiation of the Inflation Reduction Act. I’m pleased to say that, whether they listened to me or not, those companies have now followed what I recommended in that article.

Even when change happens, it’s not always what you wish for. In my September column, I talked about how a phenomenon seen in biological evolution, known as Dollo’s Law, applies in business. In short, it means that change that meets its objectives sometimes means that a firm is less effective than it was before the change. And those successes themselves may cause problems. In my March column, ‘Too much success’, I used a biological analogy to flag up that new ‘budget buster’ medicines in disease areas, such as dementia and obesity, were in danger of being so commercially successful that they might actually damage the social contract that the industry depends on. Change in our industry, I would argue, is hard to live without and then becomes hard to live with.

It was comforting, however, that even if four of my ten 2023 columns were somewhat pessimistic about change, six of them were constructively positive. January’s ‘Microfoundations Matter’ talked about how successful change begins with microfoundations of individual attributes, team-working and conflict resolution, which are in essence a firm’s DNA. In May, I used another biological parallel when I described how successful innovators copy the ‘clonal selection’ mechanism that our thyroid uses when it generates T cells. The secret lies not in generating innovative ideas but in selecting the ones that fit with market conditions. And often, since the market environment in healthcare is conservative, this means attempts at ‘transformative’ change are less successful than less exciting – but careful and incremental – change. That was the message in December’s column, ‘T is for trouble’.

The three remaining columns of 2023 were, I hope, examples of using evolutionary thinking to identify strongly practical solutions to real-world change issues that I see all the time in life sciences companies. In June’s ‘Bridge of Sighs’, a column prompted by clients who complained that their leadership hindered change, I suggested how this problem is best overcome by building a bridge. That is, defining a pathway from past success to greater future success that doesn’t require descent into a period of poor results. That’s exactly how it works when evolutionary biologists map out their ‘fitness landscapes’ to explain successful evolution. In October’s ‘Happy Accident’, I showed how new research addresses the issue of getting payers to accept that innovative new medicines and technology are valuable. This involves getting three things right – right parties, right channels and new ideas – but many life sciences companies place too much focus on the first two and not enough on the last one. In November’s ‘Corporate Cancer’, I tackled the issue of rogue, selfish departments that hinder change. They manage this by employing the organisational equivalent of what oncologists call the Warburg effect, bypassing normal resource channels. Abstract as it may seem, treating these departments as if they were malignancies is a very effective way to, if not cure them, then put them into remission.

So, although four of my columns told us that change is hard, six of them reminded us that it’s doing the hard stuff that makes change happen.

If my ten columns revealed that change is hard and hard makes change, my four longer PME articles of 2023 presented a complementary message: if a life sciences firm wants change, it has to change. And the change that really matters is the change in what a firm is able to do better than its competitors. With that in mind, I arranged these four articles into a self-contained suite about how life sciences firms decide what their capabilities need to be, how they build those capabilities and then how they sustain their capability advantage in the face of fast followers. As you might expect, sustainably superior capabilities involve not just recruitment and training, but much, much more than that.

This suite of articles, and indeed all of my 2023 publications, are available as a free download on request to brian.smith@pragmedic.com. Happy New Year!