S04 E08

Pharma's Future in the Post-Covid World


Ronnie Miller
President & CEO
Roche Canada

In the eighth and final episode of our fourth season, our host Peter Brenders talks with Ronnie Miller, President and CEO of Roche Canada, about structural change and innovation in organizations, celebrating and learning from failure, and the post-Covid field rep and office environment.



From the Chronicle Podcast Network, this is the NPC Podcast of the National Pharmaceutical Congress for June 16, 2021. The NPC Podcast was created to discuss and consider the purpose, process, and people of the pharma industry during the year of Covid. And today, we're continuing the healthcare conversation by answering questions from listeners, just like you. 


This program is presented in cooperation with Impres, Canada's next generation commercial partner. The industry is rapidly evolving and Impres is designed to help you evolve with it. Learn more about Impres tailored best in class solutions at www.impres.com


On today's podcast, our guest is Ronnie Miller. Ronnie, of course, is the President and CEO of Roche Pharmaceuticals Canada. He is also Chair of the Board of Directors of Innovative Medicines Canada. He is bound to have a few things to say in conversation with your host, Peter Brenders. But before that happens, here is Mitch Shannon, CEO of Chronicle Companies. 


Mitch, it seems we're at the end of another season.




Liona, that we are, and maybe we can start to think now about getting on with our lives as the age of Covid winds down, maybe. So we'll look for guidance to the adults in the room. 


Ronnie Miller has been the head of Canadian Roche the world's number two drug maker by dollar value for 21 years. That is an absolutely jaw dropping achievement. But it speaks to the unlikely love affair between a geography graduate of the University of Glasgow and the country where he raised his family and also led and inspired an entire generation of leaders in the life sciences. His two year term as Board Chair of Innovative Medicines Canada will end this November. Here's Mr. Miller in conversation with Peter.




Welcome to the NPC Podcast. I'm Peter Brenders, your host. In our continuing look at the purpose, process, and people in pharma in Canada, this episode speculates on the industry's post pandemic future. 


Joining us today is the industry veteran who needs no introduction - Ronnie Miller, President and CEO of Roche Canada. Welcome to the NPC Podcast, Ronnie. 




Hey, morning, Peter. 




So I've been looking forward to our conversation today, Ronnie. As we're wrapping up season four of the NPC podcast, it's fitting to have a look to the future. 


We're watching the US return to some semblance of normal, and I suppose it's kind of like, like the swallows returning to Capistrano, as I'm hearing reps returning to offices. And so I'm wondering is this a sign of spring after our Covid winter? I mean, what signals are you seeing for Canada reopening?




Yeah, I believe it is, and a very good reflection on one of my favorite songs, Peter, When the Swallows Fly High In Capistrano by the Ink Spots. 


I think we're seeing positive signs of recovery. No question. We see the patios opening, we see sports, regaining the chance to go to the pub and have a beer personally is something I'm looking forward to. It's on my bucket list. 


I can't comment on reps going back to doctors offices yet as such, but the industry's certainly on a hiring drive. I'm seeing a lot of activity from headhunters, other companies starting to build resources again. But I think as we'll get to it later in some of the questions, I think the industry has to change how it interacts with customers in this new future. So the traditional rep office visit with a doctor I think will be replaced a lot by digital contact in the future. 




I guess that is the real discussion. And what's this new normal gonna look like? So you know, I recall you mentioning on a previous NPC webinar last year that Roche had already made changes to how teams worked. Maybe you can remind us and tell us a little bit about that.




Yeah, I think it was very serendipitous, Peter, actually, we started to look at agile methodology, new ways of working. It's based on a philosophy from a former McKinsey consultant as most business philosophies are reinventing organizations by a guy called Frederic Laloux. And it really encourages an agile working environment. 


So you swarm to the topic. You try and destructure your company, take out layers, and swarms, squads, and chapters are the new buzzwords. So chapters, if you will, are the functional capabilities, and squads are knocking those people together to tackle problems and sometimes done in sprints over two or three days. So where traditionally a meeting would be held once a week for an hour, for a month and two months and three months and then maybe come to a solution, we arrive at those solutions very quickly. Part of that philosophy is to deal with what's called a minimum viable product to try and move away from perfectionism, which our industry tends to suffer from and move quickly. 


And I think the final part is trying to engage the customer and the patient more in the process than we've ever done. Rather than throw the brand over the wall. I think we now get much more involved in more detail and an example of the leadership change, and leaders no longer tell people what to do. I think we're more coaches, we call it VACC behavior, visionary, architecture, coach and catalyst. And you know, each leader has probably skills in one or two of those areas. And that's what we're trying to encourage.




It speaks to change. But you know, you've got a great record of ongoing structural changes, innovation, mixing it up. And that's nerve racking for a lot of companies, especially in our conservative industry. Do you think our industry is poised to follow these ideas of reinvention? I mean, the pandemic has thrown on us.




Yeah, I do believe that I'm heading one major company, one of the top five, certainly heavily into digital communication these days. I'm heading of another one that's actually going to give up its head office and let people work agnostically, agnostic locations. And that's a major, major change.


And ultimately, I think the customers will expect something different too. I mean, I think of doctors, we can never get a hold of a customer via telephone. But we seem to be able to get ahold of them, though, by Zoom, or Google Hangouts or whatever technology. And I think that they're very comfortable. My GP, for example, you know, I've had a couple of calls with him over the past year, he's up at his cottage, in the Muskokas, and he's loving it. And if that's the case, then the world has changed, and we have to adapt to that particular change.




Let's talk a little bit about the office piece, you hinted at that with, you've heard some companies there. And I guess that's question of reinvention as well. And I saw your company, the Genentech arm, talking about sort of return to cubicle and that it may not happen that way. Do you think that's going to sort of spread through the industry? What's this going to look like? Do we even need offices anymore?




Yeah, that's a great question. I really don't think we do in the traditional sense. So as I mentioned earlier, with squads we now give up the meeting rooms as such to a squad there are post-it notes and flip charts all over the place, there's a ban on slides. So if you think of the inordinate amount of time people spend on PowerPoint to make a perfect presentation to leadership, I think those days are gone. 


We don't even operate with a strict budget anymore, we tend to take a three year horizon. And the view is that long gone is the sandbagging negotiation on your budget. Now you can achieve 110. But you actually asked for 90, and then everyone gets the bonus, as they're trying to rip the lid off and have more bold ambition and objectives. And I think that's the biggest change that we will see.




Hold on. Those are two fundamental tenants there, Ronnie, of the industry. Sandbagging and PowerPoint slides. I mean, it's a bit of an intriguing notion, but it's almost radical in the sense. I mean, even joking aside on the PowerPoint slide stuff, I mean, we're an industry that's challenged to do detailed record keeping and minute taking. And so, I mean, how does that reconcile, you know, we're kind of becoming more risk adverse.




Yeah, I think that's true, but the key point is, what is the value to what we're doing. And I think we need to learn to stop doing things that don't add any value. I mean, over the years, you just accept this is a process, that I have to open my computer, to make sure to check my expenses, and there's nothing done. You know, there has to be more trust placed in individuals. And therefore the time that you apply to work is invaluable time. It's creation, it's driving things forward, it's interacting with customers, and if we can, interacting with patients. 


So I think ultimately, the regulations, the rules, the level of perfection will have to change. I think one thing we've got to be careful of, of course, is safety, and the regulatory process. And all those things still have to remain perfect. But the rest of it doesn't have to be. 


As a company GM I've sat in meeting after meeting after meeting, just wanting to see the final slide. Forget the first forty, show me the money, and then we can move on. Well, that's gone. Now we trust teams to learn as they go forward. And also trying to encourage people to make mistakes, we have a number of eff up boards through the organization so that we can learn from that so that we should celebrate it and move on from it, not try and bury it under the carpet. That's a change in the attitudes and very much so in a Swiss company like Roche.




You're listening to Ronnie Miller, President and CEO of Roche Canada on the NPC Podcast. 


I think every company has that sort of philosophy, that sort of risk aversion that's out there and just sort of caution on how to do it. So, you know, we have to keep our legal profession well employed. 


Let me talk a little bit, you're talking about sort of teams, putting stuff up, have your little boards so that we can recognize them, which kind of still speaks to an office or sort of a collaboration, in some sense. And you gotta wonder about sort of the social interaction. How do we keep that alive in a non office or in a virtual world, like, were there some positive developments we've seen in the last 15 months that you'd like to see sustained?




Yeah, I think personally, one positive is I've not been on an airplane since last March. And you've always got to think of sustainability and the carbon footprint that we as an industry particularly lay down. I know that Roche, for example, are one of the top five flying companies out of the US. Some of the top customer of Lufthansa, Swiss Air, United Airlines and BA I think. And that's because we've got two major centres in different parts of the world. 


Ultimately, we're learning to deal with this now in a Zoom type or Google Hangout environment. So that's one benefit. I think the other thing is that meetings don't have to take place in the office. So we're not necessarily dragged there, you can meet in Starbucks, hopefully now, the pations are open or meet in the pub, if you want to meet in the pub, or go for a walk in the park. Or as often as the case with myself and some of my colleagues, we golf together, and you can achieve a lot for four hours, you know, around the golf course, you don't have to write everything down. 


So I think ultimately, the social interaction part has been the main part that's missing. And I think you have to make it fun and get people together again, but it doesn't have to be every single day from eight to five. And we're starting to understand that, you know, biomechanics, some people are, you know, early birds, and some are nighthawks. And if you want to do your job between three o'clock in the afternoon, and midnight, fine, and often is the case in Genentech, with quite a few sufferers. They like to do stuff during the day, and work late afternoon in the evening. So I think accommodating more to different generations that have different expectations. But I think, as long as the quality of work and the outcomes are there, then we shouldn't question that.




Okay, so I get that certainly is a good approach for those in the office, but let's talk about, what about field? What's changing there? And where's reinvention? What does that start to look like for our fields?




That's a great question. I think ultimately, the days of features and benefits and detail aids is gone. And I think companies need to approach it very, very differently. We for one have just put up a new structure in place, it's called a primary point of contact. There are two types of roles. One is the patient journey partner. And I'll come back to that. And the other is the health systems partner. So in a sense, the access and policy leadership, working in a team around a key set of customers, be it a key hospital or be a province. 


Patient journey partner is almost leaning more in the medical relationship with the customer and really starting off in the clinical trial space. And then as it evolves, are we really doing what's in the best interest of the patient? If I give an example of Herceptin, you know, it's a fiber infusion, in many cases we just replaced that with a drug called Phesgo, which is basically a subcutaneous injection. If we can save the patient four hours and 20 minutes by a quick injection, then you're improving the quality of life, and it's digging into those environments in a deeper way than we've ever done. And I think the industry is gonna have to learn to do that. 


Plus, as we know, proven and diagnostics medicines will become more tailored, more personalized to suit the individual, therefore more fragmented. And again, back to the example of breast cancer. If we go back 20 years ago, there were maybe 10 to 20 types of breast cancer, now there are eighty. So I think you can be much more accurate and driven about applying that treatment to an individual patient.




Let me dive a little deeper into the people because you're talking about sort of, you know, the different types of approach here, your patient journey, and the like. But when I think about that future you describe, I'm wondering if the people we hired under the old model in terms of classic sales, or MSLs, or anything like that are ready for the new. 


I mean, how are companies going to make the transition? Are we retraining? Are we rehiring?




I think we're doing both. And I'm also sensing that other companies are doing both as well. So if we use the old adage, what got us here is not going to get us there. We've lost some of our best reps in the traditional representative mode because they're not team players. You know, and I think I learned something from an African colleague, funnily enough this week, that if you want to go fast, go alone. If you want to do something well, do it together. And I think we're seeing more of the team collaboration type environment, which will include customers and ultimately include patients, and how we interact.


And at the basis of that, of course, is data, we've always somehow bent the rules a little bit with data and obfuscate. It's clear these days, and with artificial intelligence with quantum computing, it's going to be absolutely specific, and of what the meaning of the data is, and the accessibility to that, that will change the interface, ultimately with customers.




But where do we get that data? Like at the end, our sources have been historically limited in Canada.




Yeah, well, one thing I really thinks an advantage to Canada is the AI capability in Toronto. And we, for one, as a company have signed up in that community of excellence, if you want to call us such a thing, expertise. Companies in Alberta and Montreal and also Toronto, having done it as a local affiliate, have attracted gRED, which is the Genentech research and pRED, which is Rouche research in Switzerland, are also paying attention to this now. Because the ability to interrogate data quickly and come up with a solution is just going to move things on fantastically well. And that applies right now to Covid, in a major pandemic, but it will apply to many other disease areas in the future. And that will guide how we interact with customers.




You're listening to the NPC Podcast, I'm Peter Brenders, your host. 


But what I'm hearing is the fourth wave or the continuing wave of Covid is going to sort of restructure, change our companies pretty fundamentally. So as we continue to change and adapt, you know, what should we worry about in this new normal. What concerns keep you up at night?




Three daughters and a wife spending money on a drunken sailor, but... 


You know, I think the one thing, that thing that I did worry about ultimately was PMPRB in our pricing environment in Canada. It just doesn't make any sense that a country that could have so much innovation gets crushed in that space. And I think what has changed, and I'm actually seeing light at the end of the tunnel, is the more willingness of the federal government to talk with us. Myself and Pamela Fralick is the president of the industry association, they have regular meetings with Minister Champagne of Trade and Industry, and the Minister of Health and I think together is to get the holy trinity of finance, industry and health together, and talk about how we can lay down a future for the industry. 


And I think the government got quite short in the vaccine space, and realizes that it has to balance paying for innovation and also having a sustainable manufacturing base in Canada. And it goes against the industry desires to have global supply chain. I think we'll see a desire for countries that have regional, if not local availability of original pharmaceutical ingredients. So this debate is ongoing. 


Beyond that, I think the most important thing is the poor patient. I mean, ultimately, because of Covid, cancer patients, for example, have not been diagnosed. I think we'll see a wave of illness, severe and possibly worse than that, for patients who have not been treated, have not had their surgeries because of this pandemic. And I think we've got to put the patient first. And that also then spreads into a pricing environment that doesn't welcome innovation, then Canadian patients won't get the best available treatment right now. And I think that's what would keep me awake at night at the moment, but I see positive signs of change.




Tell me about those positive signs. And so you've seen much in your career. So what gets you excited about the future?




What gets me excited about the future is the, I think the attitude is changing. I think that continuum of drug development through to patient, having patients actually, for example, part of clinical trial protocols, talking to families, getting involved, particularly for drugs for rare diseases. 


We're no longer a one size fits all industry. If we go back to the days of launching Lipitor, everyone had to take it. As I mentioned earlier, I think diseases are much more segmented and can be focused. And I think we will become, it'll be an alive dynamic environment from cradle to grave, and how do we interact? And how do we become a partner at that table. And I think we as an industry are learning to be better partners, learning to be humble, and less arrogant as an industry. Nuts, you don't think so?




It's entirely possible. 




And you know, the base of it all is science and one thing we're very proud of at Roche is the amount of money we put back into research. $11 billion a year is a huge bet on the future, trying to tie all that together. And if the industry has that approach, you know, it's for the betterment of society, everyone has an infinite desire to live as long, as healthily as they can. So we'll be around for many, many centuries to come. 




You make an interesting point about in terms of how things are becoming much more customized, almost like bespoke treatments for each person that's out there. Because as we identify, we understand our genetic profile, we understand diseases more, you said, there's 80 cancers instead of 10 and we're starting to get there. 


But I can't help but think that in Canada, we have a health system that is the average, right? It's common, we have a common drug review, we have a common approach. How much of a sense are you getting from your conversations you talked about in terms of with the federal governments and others, that our system will adapt to be able to deal with the individual instead of the masses?




I think it will take time. You never win every single battle that you fight. But I think there's a better understanding that you're going to follow that patient journey, that you start to link things like diagnosis with treatment with genetic profiling, even patient records. I mean, Roche bought into this company called FMI in Boston, who's probably got the biggest selection of cell samples in the world. So you can be matched up against almost 100,000 others with similar disease profile. In addition to that, we bought into a company called Flat Iron, who are actually doing daily monitoring of cancer units outside the major universities and following that. So if you match the data from the cell base, and then the treatment, then you should be able to zero in on what is best for that particular patient. 


Also, if you want to do a study, you can pluck 50 names from that pool and very quickly get a study started in an area. And I think these improvements will require a partnership with government and I'm seeing a more open minded government to be involved in that space. I'm also recognizing now that going beyond does bring a natural enemy, that we have to build a thriving life sciences environment and sector. You know this from your experience in Canada too. And we're seeing the green shoots of that coming from the Minister of Trade and Industry particularly. 


I saw a very interesting presentation by John Bell. So John Bell, who is the Dean of the Faculty of Medicine at Oxford University, he also just happens to be a former Roche board member, but he is Canadian. And he was talking proudly of behind the AstraZeneca vaccine and how the government, with academia and industry, got together, and then they produce this in a massive turnaround. If Canada can open their eyes to that, and I know that the Minister of Trade would like to talk with Professor Bell, and see what we can do in this environment too, we just need to tie it together and see how we can go forward.




Okay, so let's talk about that then go forward. Because we're talking two legs of a three legged stool. It sounds like to me, we got the industry, we got the government. So the third leg is the health system itself, are you hearing or seeing signals that there's a change and an openness there as well to more proactively engage and adopt?




Yeah, I think there has to be, you know, otherwise, you can't say, you can't sit in a stool with one leg, right, you're going to fall on your, your tush. And so ultimately, I think you do need these three legs, and people start to understand that. And that comes with us being a little more humble with government taking a more active interest long term because they got short on the manufacturing side. And academia does not have the resources if we compare to the US where there's millions of dollars pumped into academic research. There has to be that relationship. And if you hear from Professor Bell, he captures that beautifully to say, "everyone leaves the title at the door, joins in and says, okay, how can we move this forward?" I think we're almost there at that point in Canada to get to that space.




We have been speaking with Ronnie Miller, President and CEO of Roche Canada on the NPC Podcast. Thank you for listening.




Thank you, Peter. 




Thanks to Ronnie and Peter. 


I'm guessing that you haven't gotten enough of that level of smart discussion about the future of our business. So I want to invite you to get more next week at the summer session of the National Pharmaceutical Congress. Ronnie will be back as a panelist and joined by two other great leaders, Brian Canestraro of Intercept Pharma and Pat Forsythe of Eisai Canada, the theme will be Countdown to Pharma's Post-Covid Future. It happens next Tuesday, June 22 at 11am Eastern time. You can register now for free at www.pharmacongress.info. 200 delegates have already signed up so go ahead and claim your seat now. 


Comments or questions about today's conversation? Tweet us @2021NPC or send an email to health@chronicle.org. You can also phone our comment line at 647-873-6995. If you liked today's podcast, please share it with your colleagues. You can find it at Apple iTunes, Google Podcasts, Stitcher, Spotify, or wherever you get your podcasts. 


The NPC Podcast is presented in cooperation with our good friends at Impres, Canada's next generation commercial partner. Visit them at www.impres.com and a thanks to Will and Tiana and the team for your great support. 


This is Mitch Shannon of Chronicle Companies. Podcast Producer for the season is Jeremy Visser and he is assisted by Aria Empakeris. The announcer was Liona L Pletch. The musical theme is performed with alacrity by the NPC Podcast Orchestra under the direction of Maestro Milosh Millbrook. 


Summer's here and you need to enjoy it. Stay safe and we'll talk again soon.