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The challenges of bathing in the dazzling reflected glory of exalted technologists was front and center in D.C. this week, when Congress invited Apple CEO Tim Cook to testify about the company’s practice of “shielding billions of dollars overseas from U.S. taxes,” as Politico phrased it.
Magnificently captured by the Daily Show, the anticipated inquisition turned into a love-fest, as lawmakers fell over each other to testify to their adoration of the Cupertino, CA-based computer company.
Cook even had the chutzpah to ground his suggestions for tax code improvement in Apple’s ostensible commitment to simplicity – a principle that (as Jon Stewart observed) might come as news to anyone familiar with the iTunes TOS.
Safe to say, a pharma executive facing this committee would have had a very different experience.
It could well be that Cook’s tax reform suggestions are good ones, and that all CEOs, including pharma leaders, deserve intense Congressional grilling. Even so, there’s still a conspicuous differential between the way we think about (at least some) tech companies, and how we view everyone else.
Over at Fortune, Dan Primack raised similar questions in light of the disparity in coverage this week between the reporting of Actavis’s $8.8B acquisition of Warner Chilcott, and Yahoo’s purchase of Tumblr for $1.1B. Guess which takeout generated the most online stories (by a factor of nearly ten)?
Why, Primack asks, are “media folk so obsessed with the acquisition of a low-revenue blogging platform and so dismissive of an $11 billion combined revenue drug-maker?”
The answers, he suggests, are that tech companies are usually easier to understand, often have more telegenic CEOs, are covered by many more media sites, and are of greater interest to readers who scour web content and account for the majority of page-views.
For healthcare folks, especially those in biopharma like me, interest in understanding tech buzz goes beyond mere device envy. As life science VC Bruce Booth elegantly summarized this week, investors appear to overestimate tech returns (and underestimate life-science returns), despite compelling evidence to the contrary. The big tech wins, though almost vanishingly rare (and necessarily absent from most funds) are so spectacular that they overwhelm logic, skewing investment dollars in a fashion that contributes to the struggles of early-stage life-science companies, and arguably supports an ever-increasing number of derivative tech startups and equally derivative venture investors.
My colleagues and I in the business of making medicines find ourselves wondering why businesses built around creating new therapies are often viewed with such contempt, while gadget makers are revered.
In part, as Primack suggests, this reflects the tech publications that monumentalize each brain fart and photo-sharing app generated by the wizards of Mid-Market.
He’s also right that we feel closer to personal technologies like iPhone and Tumblr than we do to large pharma companies (or most enterprise tech companies, for that matter). I suspect most biopharmas have done a particularly poor job of establishing trusted relationships with consumers, in part due to regulatory barriers, but in part due to an increased focus on other stakeholders, such as doctors and especially payors. Because patients are often (but not always – e.g. DTC advertised products) viewed as having little input in prescribing decisions, they may be overlooked and ignored. Conversely, a distinguishing feature of some of the early, successful orphan drug companies – most notably Genzyme – was an incredibly deep-seated commitment to its patients, at an ultra-personal level.
However, I suspect that the most important reason we love the makers of amusing gadgets far more than the makers of serious medical products is precisely because gadgets aren’t essential – we can choose to purchase an iPhone, or an iPad, and, like Cook’s Congressional committee, we often find ourselves delighted with the results.
It’s not the same with medicines, usually. Medicines are a negative good – we use them because we need to (or we feel like we need to), not because we want to. We resent our medications even as we use them. We’re upset that we’re sick, we’re upset that we require a drug, and then we’re upset if the drug only helps a little bit, rather than a lot. An imperfect tech gadget still leaves us better off, but a partially-effective drug can leave us still feeling sick – as well as upset and disappointed. Undoing a negative might be a greater hurdle than increasing a positive.
A win for a gadget is if you enjoy using it every day. The ultimate win for a drug would be only needing to take it once. Many digital health entrepreneurs seem to forget that most patients don’t want their disease management to be fun, they want it to be minimized, and would prefer to lead their lives spending as little time as possible dwelling in Sontag’s Kingdom of the Sick.
At some level, I think most people understand that creating new medicines is different – and I’d argue, generally more substantive – than making clever apps and elegant gadgets. Nobody studying cancer needs Mark Zuckerberg to assure them that their work is important – or to call attention to the value of curing cancer: we all get it.
The dream of digital health, of course, is to unite these worlds, and leverage the engagement of technology to motivate behaviors that prevent or mitigate disease, and capture data that might be used to fashion more effective treatments.
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