PhRMA Hosts Tiki Barber, Talks Obsolete Game Plan
Where’s the Forward Pass?
The inaugural PhRMA Forum showed not much has changed in the game the industry has been playing for almost 200 years.
Right around the time the "modern pharmaceutical industry" begin when Pfizer was founded in Brooklyn by two German immigrants at the turn of the 20th century, college football was all the rage, attracting tens of thousands of fans to games at a time when major-league baseball teams often attracted only 3,000 — and pro football was still more than a decade away.
But it was also an increasingly violent and deadly passion.
In football's early years, yardage was tough to acquire; points were even scarcer. Wearing little padding and protective equipment, players who used their bodies as battering rams suffered not just kicks, bites and eye gouges but wrenched spines and cracked skulls.
The Chicago Tribune reported 18 football-related fatalities in 1904, mostly among prep school players. After another 19 died the following year, universities such as Stanford, Northwestern and Duke dropped football. Others threatened to do the same unless changes were made.
President Theodore Roosevelt, whose son was on the freshmen team at Harvard University, made it clear he wanted reforms amid public pressure to abolish the college football. So in December of that year, representatives of 62 schools met in New York to change the rules of the game. They made a number of them, including banning the “flying wedge" (a mass formation that often caused serious injury), creating the neutral zone between offense and defense, and requiring teams to move 10 yards, not 5, in three downs.
Their biggest change, the Really Big Disruption to the Status Quo, was to make the forward pass legal, beginning the transformation of football into the modern game.
The idea of throwing an overhand spiral was radical, credited to two men, Howard R. “Bosey” Reiter of Wesleyan University, who said he learned it in 1903 when he coached the semipro Philadelphia Athletics, and Eddie Cochems, the coach at St. Louis University. At the time, critics predicted it would dilute the sport's rugged essence and drive away fans. But it had the opposite effect.
Sustaining the "Flying Wedge"
"Tiki Barber gave me a brief glimmer of hope this week," writes Andrew Dunn, Senior Biopharma Correspondent, EndPoints News, a few days ago in Post-Hoc: Pharma CEOs' Alternative Reality with Trump.
An extended except:
"There's an elephant in the room," the former New York Giants football star said, perched in a leather chair, talking with GSK CEO Emma Walmsley in front of over 500 pharma executives, lobbyists, consultants and other industry members. [Note: The estimated fees to book Tiki Barber are $30,000 - $50,000 for live events].
Barber was speaking just a few hours after Robert F. Kennedy Jr. delivered his welcome address at HHS headquarters. I had flown down to Washington that Tuesday for the inaugural PhRMA Forum, hoping to hear the drug industry's plans for Trump's second term. Barber described a different elephant: the frustration of dealing with the layers and middlemen that get between patients and their medicines.
That was indicative of how the three-hour PhRMA Forum went. Pharma CEOs and other speakers stuck to safe, Trump-friendly topics on the stage. In the process, they studiously avoided weighing in on the chaotic flurry of actions in the Beltway.....
PhRMA also avoided including Big PBM (and Big EBC) in the low-voltage conversation, preferring to sustain the 'discursive war' two equally-matched competitors have been waging for years. This in turn sustains structural stalemate. Which in turn sustains the multi-generational "crisis" and multi-dimensional dysfunctionality that has proven impervious to "fixing" by all the money and all the technology that $5 trillion a year can buy.
Pharmaceutical Care Management Association CEO JC Scott sat down yesterday with Axios Pro: Health Care Policy reporters Peter Sullivan and Victoria Knight to discuss where the whole PBM value thing goes next (The House Energy and Commerce health subcommittee holds a hearing today on "reining in PBMs" to promote competition and lower patient costs). From that interview:
Q: Does it worry you when you see pharmaceutical executives meeting with Trump, as they did last week?
A: [Pharma has put] millions of dollars into advertising campaigns to try and define our industry and set the terms of this debate. And that is problematic because that misses the fundamental value proposition of what our companies do to lower costs, and it muddies the water, and it's not constructive.
I, of course, would expect pharma and others to be reaching out to the White House and policymakers to share their perspective. That is their job, and we're doing the same. So we'll be continuing to try and push back on that, on that message.
A winning playbook starts with a different competitive mindset. For the next healthcare to emerge, the game will have to change to a new form of economic competition at a system level.
This is less about battering the other side with the flying wedge, in a one dimensional “piece vs. piece” mode of competition, but playing a new, three-dimensional game with different rules. The process starts by see the ‘positional value’ of the markets differently.
The “price” of pharmaceuticals isn't the real issue — the real issue is working out a new general theory of markets that positions the ‘production of affordable health’ as an economic objective, where the basis of strategic competition is outcomes from new economic systems, not consumption of individual inputs. Yes, we need to reframe the conversation from election-cycle policies to generational policies with a long-term focus on getting better EBITDA from a $5 trillion investment. As any employer in any sector will probably tell you, “healthcare” is the real source of leverage, the foundation upon which everything, literally, sits.
Houston, We Need a New Narrative
Strategic atrophy is a thing, particularly in healthcare.
A $5 trillion system of markets orbits around cliché, producing content that recycles the same words the same way, a steady charge of wasted energy making happy-to-glad edits in the PowerPoints.
To wit "A successful PhRMA Forum highlights our commitment to a healthier America," Stephen Ubel's blog post following the event:
As I look back on the PhRMA Forum event this week, I’m more confident than ever in the future of biopharmaceutical innovation. We had the opportunity to hear from some of the most forward-thinking leaders — researchers, entrepreneurs, and patient advocates — on what it will take to strengthen America's innovation ecosystem and break new ground in health care.
From AI’s potential to transform drug discovery to the urgent need for policies that support innovation, one message was clear: If America wants to remain a global innovation leader, we must be bold. Bold in our vision, bold in our collaboration, and bold in our commitment to delivering the breakthroughs patients need.
It’s incredible how much the standard of care for many diseases has changed between then and now. Today, we can screen a person’s genome for mutations. Cancers can be targeted using a body’s own cells. And many of those diseases that lacked treatments now have medicines that abate symptoms and effectively cure patients.
This progress is in large part thanks to researchers across America who used disruptive thinking to develop and test treatments that have revolutionized prognosis and treatment. These medicines have saved lives and improved patient outcomes.
Which is a half-thought thought, the sound of one hand clapping, a fragmentary frame born from a zero-sum view of competition in a non-Zero-sum game. The really disruptive "disruptive thinking" that's missing is the story around cross-sector economic innovation to bring all this disruptive technical potential to market at scale, in an organized and persistent way. (Think 'the production of affordable health' as a Large Language Model around which markets are forced to cohere.) Meanwhile in late-breaking news of the "disruptive thinking" Ubel says is "critical to protect our ecosystem and remain the global leader in innovation":
Moderna shares are down (again) on reports HHS is reviewing its $590 million contract to develop a bird flu vaccine
Novavax reports (another) large quarterly revenue decline, said it no longer wants to be known simply as a vaccine maker
FDA has canceled its meeting to select flu strains for next season shots
FDA and CDC are going outside "the ecosystem" Ubel wants to protect, turning to the World Health Organization to discuss next winter’s influenza vaccines (this despite the Trump administration’s plans to withdraw from the global health agency)
A child in West Texas is first US measles death in a decade
RFJ Jr. dismisses measles outbreak as “not unusual” after child’s death
There's a reason Pfizer CEO (and new PhRMA chair) Albert Bourla received loud boos when he was introduced by Donald Trump at the White House. That reason is this:
The foundational pieces for everyone have disappeared. That status quo has collapsed. It is gone. That collapse is not a future state. It’s a current state.
We are in the midst of a massive transformation coming at us with a speed and level of intensity that no one has faced before. Society has changed. The underlying economics have changed. Business + government has changed. The information environment has changed. It’s not like just returning to the old status quo is the answer. We’re at the center of the tornado right now, and it seems like it’s whipping all around us. And I don’t think anybody really understands how to make it stop.
The roadmap to the ‘next hundred billion in growth’ begins and ends differently, with an intentional reorganization of markets into new economic systems, which are then managed as a single organism ('ecosystem-centered market strategy').
The Problem everyone seems to be struggling with is finding and communicating strategic fit to the rapid and intentional disassembly of the old order, to a world transitioning from Newtonian economics to a world of quantum economics, where two things that seem to be in opposition can be true at the same time. Like Big Pharma collaborating with Big PBM as a system on big market innovation.
Which, I would argue, is what 'value alignment' with Make America Healthy Again is really all about.
It's time to invent the forward pass.
/ jgs
John G. Singer is Executive Director of Blue Spoon Consulting, the global leader in positioning strategy and innovation at a system level. Blue Spoon specializes in constructing new industry ecosystems.