Reason to Believe

The other day I was invited to give a talk at an industry event. I spoke about some of the challenges I see coming for the industry, then sat down and listened while Doug Long from IMS Health gave a presentation on the state of the pharmaceutical market—the patent cliff, the slowing growth in developed markets, the dominance of generics, the whole shebang. At the close of the day, I said goodbye to Doug. "Pretty grim," I said. He looked at me. "At least I was more optimistic than you were," he said.

Patrick Clinton

I was taken aback. Because the fact is that, though I spend a great many of my waking hours thinking about bad things that

might be happening to the industry—the way a watchdog spends a lot of his hours brooding about burglars—I'm optimistic about the future of the business of discovering and making medicines. There may be tough days ahead, but there's a dance or two left in pharma.

So what's there to be hopeful about? Here are a few things:

There are great drugs coming When we talk about dry pipelines, we're mostly talking about late-stage development. Back in Phase I and II, there are so many candidates that they'll probably create a crisis of oversupply as they move toward approval. We'll see new methods of action, breakthroughs in efficacy, new side-effect profiles, patient-friendlier drugs—and beyond them, the promise of the latest discoveries of science.

The sales force is out of the driver's seat The last few years of the great Pharma Arms Race were pure madness. It was obvious that huge sales forces, a blockbuster mentality, and who-cares-about-the-customer selling were alienating doctors, demolishing the industry's reputation, and attracting the wrong kind of public attention. There will be pharmaceutical marketing and sales in the future. (Okay, Mr. Obama?) But the structural changes in healthcare over the last few years nearly guarantee their sanity.

There are new leaders It's never easy to change the course of an industry. It's even harder if you were around for the glory days. Pharma needs a generation of CEOs for whom the glory days are still ahead, and it's starting to get them.

The money's not all gone Pharma isn't going through a slow downward spiral like the newspaper industry. It's getting ready to drop off a cliff. And if you're prepared to act quickly, a cliff is not death, it's just a deadline.

The specialty drug market is breaching the barrier between patients and pharma in productive ways. Attribute it to payers' drive for data on comparative effectiveness, or to FDA's insistence on better risk management, but we're starting to see companies develop new relationships with the people who take their drugs. Those relationships will have to be handled scrupulously, but I'm betting they'll be a good thing for all.

The uproar over safety of the last few years, though overblown, was necessary. Drugs aren't consumer goods. They're not supposed to be. To work well and safely they need a level of commitment and knowledge on the part of patients that arguably we haven't had. Patients should start to take drugs more seriously.

There's still plenty of need The best part of this job was never about making the numbers. It was about overcoming disease and suffering. And this may be a funny way to express optimism, but don't worry, the enemy is still there waiting to be beaten.

Have a good fight.