Episode 1: Doing Right by Patients and Delivering Financially Are One Job, with Charlotte Rocker

Final transcript, lightly edited for readability. Timestamps are synced to the video and jump to that moment when clicked. The views expressed by guests are their own.

00:04 Patrick Coyle: Thank you everyone for joining today. I created Patients and Profitability because I spent my career seeing what happens when patient access and health care economics become disconnected. Most organizations manage those separately. I believe they’re actually the same conversation. When patients struggle to access therapy, businesses struggle, too. My work focuses on helping organizations better connect patient outcomes with financial sustainability. This is the first episode, and I wanted to start with someone who’s worked both sides of this business. Charlotte, welcome. I’d rather introduce your you introduce yourself than have me do it.

00:39 Charlotte Rocker: Sure, Patrick. Thank you, and thank you so much for having me. So, Charlotte Rocker, I’ve been in the life sciences industry for just about 20 years now and have looked at it from a lot of different angles, everything from working as an emergency medical technician to clinical research to consulting and startups. For the last 6 years, I’ve been at a pharmaceutical manufacturer, so been part of Novartis Pharmaceuticals.

01:03 Patrick Coyle: Thank you, Charlotte. I’m so honored That you’re here with us and our guest today. So, here’s what struck me when we first talked. We covered oncology, data, leadership, career paths, but what we kept circling back on was one question. Whether doing the right thing by patients and delivering financially the same job or two competing ones. You’ve now watched that question from almost every seat there is. So, let’s start at the beginning. You’re working clinical research, then you moved into PR, advertising, consulting, startups, and health data before you even sat on the side the seat of a manufacturer. What pulled you into this work and what made you sit?

01:39 Charlotte Rocker: Yeah, I think it’s always funny in hindsight we have these kind of linear paths, and while you’re actually going through them, they look a bit more like this. I think what attracted me to healthcare in the first place, I wasn’t somebody growing up who’s had, “I want to be a fireman,” or, “I want to be a doctor.” I knew I wanted to help people, and I didn’t really know what that was going to look like for me. I had initially planned, having been a psychology major. In undergrad, to pursue a graduate degree in clinical psychology, made a decision not to do that, and fell into my first job in the industry, which, as you said, was in healthcare public relations.

02:17 So, I was on the agency side supporting life sciences customers, in that case helping to launch a, at the time, kidney cancer drug that then also became a liver cancer drug. And that was my first exposure to drug development as an industry. Somebody fresh out of college kind of going beyond the science of what I learned in classes and seeing how that science really turned into a business opportunity. And I think that what’s kept me in the industry over time is you can influence people, you can influence business in a lot of different ways, but to have patients, to have healthcare and healthcare outcomes at the core of what you’re doing, and then through working at a place like Novartis to have the

03:06 Opportunity to really have that impact at scale. So, influencing thousands of patients, tens of thousands of patients, depending on the type of product that you’re working on, sometimes even more than that. I think that’s been what’s really appealing and what’s kept me at Novartis in particular, is really seeing that ethos, and I know we’ll talk about this more, but seeing that ethos owned and pulled through by our leadership, that we are fundamentally a patient-first organization. Yes, we’re a for-profit company. That’s why we choose to operate in this industry as a manufacturer, but we do that because of the impact that we believe we can have on patients and customers, and that’s why I do it as an individual as well.

03:50 Patrick Coyle: Yeah. So, yeah, thank you for that. And I also want to add the disclaimer that all of the thoughts here are our own opinions and not those of our organization. So, what was the first moment that it stopped being abstract work for you and you felt the touch of a real patient? That’s your end.

04:08 Charlotte Rocker: Yeah, I—it’s actually really going back to those psychology days. The internship that I had in college, I was essentially a research assistant in an outpatient psychiatry office, and the belief of that office was that if we standardized psychiatric diagnoses, then we could better diagnose and better treat those patients, which in turn would lead to better treatment outcomes. And initially, I was watching the clinicians, the psychologists and psychiatrists, administer this interview. I was doing the data entry, and eventually, I trained on the interview module myself, and then I became the person that patients saw when they first came into the practice. And I very distinctly remember the first interview where I—and I’m obviously not going to name this patient or share any identifying information—going through the interview module on depression and asked our standard question of whether this patient felt like they were a danger to themselves or others, and the

05:07 Patient started crying and basically said that they didn’t feel safe going home because they were worried about what they were going to do to themselves. And I brought in a supervisor, I brought in a psychiatrist who had the same conversation and came to the same conclusion I did, and at that point, you have an obligation to admit that patient to the hospital. You can’t let that person go home. And our building was over here, and the main entrance to the emergency room was over here. So, I had to walk this person from the office where I had seen her over to the emergency room to make sure that they could get the care that they needed.

05:43 And that was—I had seen hundreds of these interviews, I had coded data for thousands of these interviews. It was the first time that it was my clinical judgment to make a decision on what needed to happen in order to best support somebody. And I’ve never forgotten that patient, and I’ve never forgotten the depths of the obligation that we have to the patients that we serve as people who are privileged enough to work in this. industry.

06:10 Patrick Coyle: That’s amazing. But thank you for sharing. I think when you meet so many people on the manufacturer’s side, I do have and I have and developing these life-saving therapies every day, you forget that everybody has a job to do, but behind there is this myriad of experiences that don’t manifest anywhere near the job description, and that shape you and who you are. And I just think that’s absolutely amazing. When you were at So, we if we jump ahead a little bit, when you’re at Flatiron, right? So, now you’ve seen that patient firsthand, somebody that needs help. And then you go into Flatiron, and you’re closer to the data than than a drug company will be in the future.

06:51 What did that look like crossing over from seeing a person in need of help to then all of a sudden you’re looking at data, and you’re seeing the journey of a patient? What did that look like for you?

07:03 Charlotte Rocker: Yeah, I think I started to talk about the ability to have these impacts at scale, and I think that was Flatiron was Probably the place where I got closest to that for the first time, because you help when you’re working in consulting. You do these projects, you’re helping a client think about what therapeutic area should we enter, or what product should we prioritize, or should we buy this company? And those do have ultimately patient impacts, those decisions, but they’re much further down the road. And when you work at a place like Flatiron, the source of our data is the electronic health record. And so, we had our own OncoEMR, was the name of the platform.

07:45 We had our own platform. We were pulling data from other EHRs services so that we could see all of that kind of aggregated. But whenever we had to QC something, if we’re putting together a data set, especially once you got into really narrow indications that maybe you couldn’t study or couldn’t explore in the context of a clinical trial or regulatory environment, I opened up patient charts. I was seeing patient documentation of side effects or those types of surveys that patients fill out. Physician notes. And if that you zoom into that patient’s journey, that patient’s story, but then you zoom out to okay, who else is experiencing that and where do we see it and what are the trends we see in that and what can we do with that data to help patients benefit from these drugs more, to help better identify which patients might be at risk for certain adverse events or certain toxicities.

08:43 Can we use this data to explore approval of a product in an area where maybe it wasn’t previously approved? So, I think it’s that sort of light bulb that this person’s story is very real and for them it’s all consuming. And there are also other people out there who are experiencing the same thing. And when you’re privileged enough to have access to that information at scale, you have the opportunity to have impact. Beyond just that one patient, and maybe impact people who might even not have the disease or the diagnosis yet.

09:19 Patrick Coyle: It is fascinating because you went through seeing journeys in person, right? And then you start seeing journeys in data. And then on our first call, we found out that we both started in oncology. There’s so many things that we had in common. So, actually, I found another one I didn’t think about. So, I have an in psychology and sociology.

09:38 Charlotte Rocker: There you go.

09:40 Patrick Coyle: Abandoned so long ago, but I think it helps me. I think I have been, maybe I’ve been in the education, but not in the practice, right? But it helps me look through a different lens. One of the other things was we both started in oncology, on the commercial side for me, but actually in R&D, working on the same molecule, but from totally different seats, right?

09:59 So, you’re on the agency side. I crossed over from finance and IT into pharma and supporting Nexavar, sorafenib at Bayer, or Bayer, right? And managing the R&D side before I was working in the US. Tell me a little bit about when you found out about liver cancer data for that from the other side of the lens.

10:23 Charlotte Rocker: Yeah. Yeah, I was at a public relations agency in New York City. We had a sort of joint client relationship between Bayer and Onyx Pharmaceuticals at the time. And initially, exactly as you said, sorafenib Nexavar had the renal cell carcinoma indication. And this is in the early days of tyrosine kinase inhibitors. We can date ourselves by, what was the first TKI that you worked on? And I’m dating myself quite far back with it being Nexavar, but when they were studying it in liver cancer, in hepatocellular carcinoma, there were no targeted therapies approved for that particular cancer. It was a terrible diagnosis. It remains a really challenging diagnosis. And ASCO, the American Society of Clinical Oncology annual conference, was coming up.

11:12 And we As the agency were notified that the HCC, the hepatocellular carcinoma trial, had actually been positive. It had actually meaningfully improved its primary endpoint for these patients. And that was not expected. It was going to be a late-breaking abstract. And what that could mean for patients and what that mean for providers looking to to find treatments for patients with this disease was incredible. But, one of the, from the public relations perspective, it’s very important to keep that data embargoed until the official announcement comes out, until the official release at the conference. And I’m an early 20-something working in my first job out of college in New York City. And I get this frantic phone call from our managing director that some outlet in a small Midwestern state had somehow broken the embargo, not intentionally.

12:09 They weren’t like trying to break a story, but whatever queue they had set up on their website, they had accidentally released the press release. Before it was meant to come out. And I get this frantic phone call that it was my job to stop that and to get them to take it down. And of course, this was all automated. It’s close to midnight on a Sunday. Nobody is at that office. I was not at my office. I was at home getting a very upset call on my cell phone from my partner at the time. And there at the end of the day, there was nothing that I could do. But that’s such a small piece of such a big story.

12:43 But again, I talked about how I would never forget that patient who I walked into the emergency room. I will never forget the first presentation that you see at a conference like that, where people are clapping, where people are standing up, where people gasp when they see the data. It validates everything that our colleagues and I have done leading up to that moment, that you’re able to bring an outcome and an evolution like that to these patients and to these clinicians. I think it’s, again, I keep using the word privilege, but what better impact can you ask to have and can you be lucky enough to have in your career, even if you only play a small part in it, that part still counts.

13:27 Patrick Coyle: It’s such a powerful reminder that people show up every day and it’s a job. Right? I don’t, right? Whether you’re on the manufacturer side or you’re on the service solution support side, it’s an ecosystem that has to be perfectly orchestrated together to have these outcomes. And then, like you said, you’re at this pivotal moment where you’re going to change the—you’re part of seeing the change of how this disease is going to be treated forever at that point onward, and the hope that it gives to patients. And I just think it’s amazing. I was fortunate enough that the, the brand lead for Nexavar in the US when I joined the commercial team, John Collins, was a huge advocate for orchestrating the ecosystem.

14:10 And he brought me to ASCO and he brought me to meet with these key opinion leaders and then to discussions with patient payer. Payers and patient access organizations, and I got to see how all these different sides come together in the same journey. And I think, I really hope that out of this there’s manufacturers that send people. I was a finance guy, right? So they send a finance guy to ASCO to feel the power of that moment, or moments like those where you’re part of something, because otherwise it feels like you’re just in a job. Nobody in a pharma company is just in a job. Everybody is contributing to this amazing outcome of changing the world every day.

14:54 So, what do you think about it? There’s a system willing you accept different types of evidence, right? We’re going to fast forward real quick into the future and then go back to group chat. The more and more I talk to people out there really heavily involved in technology and clinical evidence generation and data, what do you think can happen in the future now of accepting different types of data as evidence and maybe some of that is the lesson learned with Flatiron where you’re getting the EHR and the output of that data in the visualization on a journey. That is real. That is real world experience and I did work at IQVIA and other organizations that the data is a huge part of what’s going on.

15:38 But what do you think’s going to happen next? Do you think we’re going to change the way that data, you know, that evidence generation, it is incorporated into the process? This is all conjecture.

15:50 Charlotte Rocker: Yeah. Yes, if anyone has access to the crystal ball to accurately answer this question, please find me on LinkedIn and and tell me what that answer is because I would love to know. I think that there’s places where technology can and should influence this cycle because one of the things that we need to do is we need to get these products to patients faster while also making sure that we’ve Studied them sufficiently to understand their efficacy profile, to understand their safety profile, so that whatever products enter the market, while they haven’t been used at scale in a commercial environment yet, we have the best possible confidence that we’re launching something that is effective and that is safe for patients.

16:34 So I think there’s, even before you get to the step of what is the actual clinical data, how can we apply technology and AI in the drug discovery process? Can we speed up target identification? Can we somehow speed up some of the early PKPD investigations so that maybe we can extrapolate from a more limited set of data to make those conclusions? It’s not a part of the industry that I’m close to or that I talk about, but there’s still a lot of animal testing that happens in those early stages. Is there a way to reduce that by increasing technology? And then when you get into the clinical trial setting, particularly if you consider products That may be attempting to be developed in places where there have been no approved therapies before, or the diagnostic journey may be really difficult for these patients.

17:30 Can we identify those patients faster so that they can get into a clinical trial, they can have access to an experimental, innovative therapy that may make a meaningful difference in their disease state? And then, exactly as you’re saying, can we somehow—it’s not right, I don’t want the bar to get lowered, but I want us to be able to climb those, to step over the bar faster. So, how do you get there faster? Can you use real-world evidence as part of that data package, which obviously is only valid once the product’s already on the market, but for a product that’s still in clinical trials, well, what if we can get the patients in there faster, can we better identify the endpoints, can we better power those clinical trials somehow?

18:13 But all of it is with the goal of getting the products to the patients, being able to impact those patients more quickly. And then, the name of the podcast is patients and profitability. If we get to that milestone faster, yes, the company will be in a position to to recoup that investment sooner. But, for a place like Novartis, that means we have access to more capital more quickly to reinvest back into research and development, which is the the core activity that we’re doing, or to support parts of our portfolio that don’t have any profitability attached to them. So, Novartis is very involved in malaria and in neglected tropical diseases. Those aren’t areas where we make any profit off of our drugs.

18:58 We’re distributing those at cost or sometimes even below cost to markets that need them. We can only do that if we have the profitable side of our business. So, I think it’s exactly as you’re saying, if this ecosystem is going towards the place of positively impacting patients, and in doing that, we positively impact our business model as well.

19:19 Patrick Coyle: I love it. Back in 2016, when I joined Novartis, I saw this great tide coming of such a concentration of focus on the patient, right? And people forget, like you talked about, it costs up to $2 billion to bring a new product to market. And that’s, I think, that’s—you’re lucky to have that happen. Yeah. And with everything else in news, people forget how much innovation costs. And there’s so much downward pressure on the profit margins for pharma brands and companies today. It’s a long tail, right? So, the impacts of some of these things that are going on right now. You don’t stop trials, right, midstream. And it’s going to take a long time. And I think to really feel the pain of that on the pipeline, especially smaller companies.

20:02 But I think you really hit on something. You think of a sliding scale of, okay, it’s standard of care, it’s that well-established, right? Multiple similar therapeutics out there in the market. And then the other extreme was like nothing, right? Completely unmet need in rare disease population. And you can’t cost $2 billion to help them. I think there’s got to be some use of technology and data to to help identify and expedite and empower appropriately in a new world. And there’s some really cool technology companies out there doing that. But, I think the regulatory landscape is going to have to catch up to that. So, moving to a different part. You said something that really stuck out with me last time.

20:42 I wanted to really drill on it. It’s near and dear to my heart. It’s you said do well by doing good. And I haven’t stopped thinking about it. And you have to believe the way you meet obligations to shareholders is by driving that impact for patients, like you talked about. Those two things have to coexist together. And if you don’t believe that, we’re all probably in the wrong business, and right? As the former CFO of Asia and the Americas, I learned all about how you have to continuously fund innovation in the pipeline, especially in in Alzheimer’s. It’s very expensive to bring those products to market, but has it ever been tested when there’s a decision to make that you see, that’s specific to an organization, but where you see, okay, profitability is eroding, we have to make sure we find an alternate path to do something cheaper, faster, to make sure that patient journey continues.

21:35 Charlotte Rocker: Yeah, it’s a great question. I’m speaking to it at a high level, but I what I look at and Novartis is navigating a huge patent cliff that was triggered last year with the loss of exclusivity of our largest therapy ever in the United States, which was a product for heart failure, and then two other substantial therapies as well that were in the hematology side of the business. And navigating all of those at the same time, every organization goes through some version of that, and you see the things that you expect to see, right? Adjustments in operations, you may see reductions in field force or in team size. One thing you haven’t seen with Novartis, which I think actually surprised me, honestly, is you haven’t seen a drop in our stock price.

22:24 And I think that the company has done a great job of telling the story of this is the impact that we expect from these, and this is how we’re building beyond it. And we’ve been fortunate in the approvals that we’ve had, we’ve been fortunate in the the clinical trials that we’re doing, we’ve been fortunate in some of the acquisitions that we’ve been able to have, but I think it’s really interesting to see how a company, when you have that focus, exactly as you’re saying, is we’re here to do what’s best for patients. We’re not stepping back on R&D, we’re not stepping back on, okay, we’re going to narrow our pipeline. We’re going all in on the four therapeutic areas, oncology, cardiovascular disease, neuroscience, and immunology that are the foundation of our business and keeping our commitments to those.

23:11 There are other places where we can look to maybe improve our margins, but those are things we’re doing on the back end. And those are also things that we’re doing with the goal of being able to serve patients better. Can we make improvements in what our patient support looks like? Yes, in a way that’s more efficient, but that also so means that there are fewer points for providers who have made a clinical decision to prescribe a therapy to a clinically appropriate patient. Can we shorten our marketing review timelines so that we can get material and information out to customers faster? Again, it reduces margins on our side, but it also gets physicians the information they need to make an appropriate clinical decision.

23:54 So, I think I’m living how a company navigates a moment like that right now. And we absolutely are making changes, but I think even in that context, for the most part, and I don’t mean to downplay the impact of when it is a head count reduction cuz that is part of this and that is a very painful thing to go through. But the operational improvements, the technical improvements I see us making really are that both and of what do we need to do to improve profitability, but at the same time do it knowing that it’s what’s right for patients and it’s what’s right for customers.

24:30 Patrick Coyle: That’s excellent. I pride myself on helping to teach finance about some of those types of patient programs and support. And I know Novartis does a great job with that, but some companies out there that are not Novartis, when capital gets constrained and they don’t have the portfolio where they can continue to rebuild and and fill that pipeline, they make some decisions that sometimes put the patient journey at risk. And I And my hope is that the education for both the patient access teams on what finance needs continue and then finance needs to understand on the patient journey that we keep funding those, right? Because after after time, the messaging is out there, but the programs that the patients need and that come to count on to continue their therapy is really critical to keep funding.

25:18 Something else that came up really interesting in our conversation was the difference between surviving and living. And in some cancers, we’ve won the survival argument and patients now live closer to a normal life. There’s a lot of moments in an organization that they would declare victory and move on from the money, but from a profitability perspective, but staying in that space and really doubling down. What to you in your mind is the difference between a patient surviving and a patient living? And what is treatment-free remission? So someone who’s never heard that term, and how does that power you to keep chasing the things that you’re doing and involved in?

25:56 Charlotte Rocker: Yeah, for any of us, and we were talking about data at the beginning of the conversation. Survival is data. Survival is a Kaplan-Meier curve, right? What’s how what percentage of patients are alive at a given time point or who have stayed alive at a given time point without their disease progressing? And a patient who has no toxicity on their product and a patient who has a grade four adverse event on their products, if they’re both alive at that time point, look the same on a Kaplan-Meier curve. Those patients are having a completely different experience of living. One of them is able to go to their kids’ graduation, go to their grand their grandchild’s preschool parents’ night, or play with their dog or their cat, do their gardening, do their hobbies, travel.

26:50 The The patient is probably in the hospital. And I think when we have the opportunity, and you don’t always have the opportunity in oncology just because of the nature of the disease state, but when you’re talking about chronic disease management, which as you say there are some forms even of cancer and certainly in other therapeutic areas, there are chronic diseases now that patients are living with every day and managing every day, we’re not just talking about survival anymore. We’re talking about living and about quality of life. And it’s a harder end point to prove. It’s a harder trial to design. It’s a harder thing to communicate to the market. But it’s one of those things that that we know it when we see it.

27:37 And I think all of us who have been through any kind of a health journey, as soon as those kind of things that you take for granted, getting out of bed, being able to pick up your little kid, being able to get in the car and drive yourself somewhere, as soon as those things are taken away, you know the difference between living and surviving. And I think we forget that difference sometimes when when we’re just looking at data on a page. Treatment free remission, and I’m not a scientist. I’m not going to talk about any specific product in this context, but that’s a concept that has come into place in the chronic myeloid leukemia landscape over the last several years where because we have these products now that are and I say we, I’m talking about the community overall cuz these are manufactured by a variety of different companies, but you have products that have gotten patients to such a low level of the of the cancer in their bodies that those patients are actually able to in some cases come off of treatment and stay off of treatment for many years while still keeping their leukemia controlled.

28:47 And when you talk about that, that difference between surviving and living, even if a product has relatively minor side effects or a relatively favorable safety profile, there’s still going to be some things. And if you’re taking that product every day, you’re going to contend with those things every day. And the idea that when some cases we’ve innovated to a place where maybe the patient, even with a leukemia diagnosis, has that opportunity to come off of therapy and stay off of therapy, how fortunate are we to be able to offer that to some subset of patients. So, I think that’s that’s the holy grail for this particular type of leukemia that I work in today.

29:30 Patrick Coyle: I love it. Two things that come to mind are one, that the the continuous innovation is improving the the living, just not surviving, right? There’s a lot of new methods, mechanisms of administration, and products that’s subcutaneous injections versus chemo infusions. And things that are making even the quality and of care at the point of administration is improving in oncology. So, it’s really exciting. The one of the things I remember on Lenvima was when we couldn’t provide the right support and community gave the right clinical intervention, the difference between saying on therapy with having hand-foot skin reaction and crawling across the floor for a patient for more than the first 24 hours was often the difference of titration, right?

30:17 And you could actually improve that by titrating and staying on therapy. And the outcomes that were so much more more clinically different in the real-world practice. So, I just think amazing opportunities that that again, same therapy, same patient, like you said, therapy is the same, but different experience. So, if we switch to leadership for a moment, tremendously important to both of us. We both live on different sides right now, and so you spent years helping manufacturers, probably inside perspective. Now you sit inside one, I spent years inside manufacturers, and now I’m on the outside and helping to advise them. Same vinyl record, right? Different sides. What I keep coming back to is not just about two businesses.

31:04 They really have to come together for that common understanding. So, what did leading from the other side teach you that you use every single day now? And what do you understand about your partners that you wish maybe either you understood then or that others around you understood, because you’ve been in both both shoes?

31:19 Charlotte Rocker: Yeah, it’s a great question. I will also say anytime we’re making vinyl record analogies, we’re also dating ourselves in addition to what TKIs we may have worked on in our careers. Probably no one who’s listening to this is someone who’s young enough never to have heard of vinyl, so we’re probably okay. If you have the opportunity to spend time not just with the CEO or the the leaders, the outward faces of the organization, but the people who work in a place at Novartis, all up and down the chain, whether they’re in one of our manufacturing sites, whether they’re one of our sales representatives, whether they’re somebody in headquarters, whether it’s somebody in finance, nearly all of those people will have a story of why they choose to put their time into this industry.

32:06 And it’s a connection to a patient, it’s their own personal health journey, it’s their kids’ personal health journey, someone in their family, someone they loved, someone who’s still alive or someone who’s passed away, but there is an intrinsic motivation that comes from watching or experiencing a health care journey and then making a choice to contribute to this industry rather than work somewhere else or in another space. And I wish that people had the opportunity to hear those stories as much as I’m privileged to have the opportunity to hear them internally because they are incredibly meaningful and really get to the core of why we choose to do the work that we do. There’s the You always wish that the other side had the understanding of the complexity, right?

32:53 What does it actually take if we’re talking about the communication space? What does it actually take from the agency side to develop a marketing campaign, to develop a communications campaign? Sometimes I feel like we think that you can just spin those things up and there’s real work and real thinking that has to go behind it. So, I always wish we could shine a light on each other’s processes more than that, but I think on the on the client services side, you’re just that much more removed from and what the ultimate outcome of the project, the question is. And when I see people burn out in those spaces or decide that they want to do something else, it’s often because they haven’t had the opportunity to know how that loop was so I try when I work with vendors even if the project is done, if it has a life beyond that, I do try to loop back to that team and say, “This is what we did.

33:48 This is what we decided. This is how you helped.” And I think that helps those teams feel more connected, understand what their work went into. So, that’s something on the client services side that I wish we did better as the client is to make sure that we close that loop for people cuz it lets you feel more of a connection and a purpose to the work that you do.

34:08 Patrick Coyle: There’s so much there to unpack, I think. That’s amazing. I think that’s the power of amazing leadership that puts patients first and reminds employees of the of what their jobs are, right? And the accountability associated with that. Yeah, I think like you said, not every pharma company operates with that. Some operate only too much on the profitability side and don’t focus enough on the patients as ironic as that is. Not yours, but there are some out there that make the bad news, and I think what we all could do is learn lessons from what works really well. And maybe, like you said, highlight the these amazing experiences that that are beyond the job description of the team, and let others learn from that, too.

34:51 It’s just as important as learning from what’s going on with the patients. And then I think the other thing, too, is the empathy, right? The empathy for patients is one thing, but the empathy for people where you knew what it was like with tough deadlines and high hard expectations and, you know, coming in to the organization. Every company has their own identity. Sometimes that lives longer than than leadership is there, and sometimes it doesn’t. And so, whenever you’re there on the manufacturer side, it’s at a point time, right? And so, you brought in this knowledge of how things work on the outside. And for me, what was really helpful was coming to this side and knowing how the inside works, right?

35:31 I know the bureaucracy of a lot of organizations, and not all the technology fits together well, and maybe legal takes longer to move contracts through and these things. And I think what I would ask other people out there in the advisory community or consulting community is to just try and understand what’s happening, right? Inside a manufacturer, there’s a lot of moving parts, and to be patient with that. So, one of the things that we did talk about and I you know, we’ll start to wrap up is you go through research and clinical development and commercialization and global launching and brand management. And then you get into the operations of the real world. And so, my side of it is I spend a lot of time at work in what happens after the science works.

36:20 So, you’re going with hubs and specialty pharmacies and limited distribution. All these different people are helping to manage the operations. I see fractured patient journeys all the time, but it’s very hard when you’re on the inside to look at your own journey maybe the same way objectively that I can on the outside. So, where do you think most of those patients fall out of the journey or how much of that is visible in the data versus hearing anecdotally? Yeah, and if you could maybe if you could design one thing to help bridge that gap, what would it be?

36:50 Charlotte Rocker: You build a patient funnel, right? If whether you’re thinking about how to bring a product to market for the first time or whether you’re a finance person building a forecast, you’re going to think about what percentage of patients have this condition, what percentage are diagnosed, and what’s the time frame to diagnosis, what percentage are treated, how long do they stay on that treatment before they go on to the next therapy, etc., etc. And I’ve seen those models built and developed in a lot of different places. I think if we do our job well, we feel a real obligation to bring those those patient journeys to life so that we’re not just thinking about numbers and statistics, but so that we really understand what it means to be a patient or a clinician navigating that experience.

37:40 And it’s not easy, but you can sit here and say, and I’m completely making this up, the the average time to diagnosis for disease X is 3 years. Okay, fine, that’s the data point. But if you’re that patient, what does that mean to be told that your symptoms are one thing and then they’re not, to be getting tested and to have those tests be normal when you know that something’s not normal, what are you going through and your family as you’re navigating that? And I think that’s the the responsibility that we have irrespective of what function we’re in is not just to make sure that we have a solid understanding of the information because we need it, but to make sure that we humanize that information and that we really understand the human experience that goes along with it from the patient’s perspective, from the caregivers perspective, from the physicians perspective from the advocacy groups perspective because all of those different people all of those different stakeholders are going to play a role in how a treatment is adopted in that space.

38:45 So, you know, you talked about being able to be taken to ASCO. When I worked at Flatiron, whatever function you worked in, you had an opportunity to sign up to shadow one of the clinicians that we had on staff in one of their clinic days and practice and to see how they were actually interacting with patients and for us from a technology perspective how they were actually using our EMR software and I think that builds a lot of empathy for what’s easy to say, “Okay, we’re going to install this workflow and that’ll take two more clicks.” Fine, that doesn’t sound like a big deal, but how many clicks is that doctor already going through to get through whatever they want and is it really just a click or does that click trigger a pop-up and then you have to navigate this and that or it violates something on their pathway and now they’re getting monitored for this.

39:33 It’s you can’t have the empathy that you need without finding a way to connect authentically with that experience. So, I think you need both. You need the data, but you have to understand what that data means from the experience of the patient, the experience of the provider, of the caregiver to understand how you can meaningfully beyond I say just it’s too simple, but beyond just having a treatment how do you actually make that treatment something that doesn’t just manage symptoms, but improves the way that patient lives.

40:07 Patrick Coyle: I love it. I think there’s this opportunity to not just look at the data and not just do the research, but actually live inside that journey on a regular basis and see how it keeps twisting and turning for different patients, different providers, different pharmacies. I tremendous opportunities and excited about what the future holds and I just wanted to say thank you so much for your time. I couldn’t have thought of a better first guest to kick off our series with episode one of patients and profitability. Please also thank your colleagues and keep up the great work because our patients are depending on it. So, thank you so much for your time.

40:47 Charlotte Rocker: Yeah, likewise. A pleasure to be here and thank you for having me and for having the chance to contribute. Good luck with the podcast.

40:53 Patrick Coyle: Thank you. Patients and profitability are not competing priorities. They rise and fall together. They’re the same [music] mission. Thank you, Charlotte.

41:00 Charlotte Rocker: Thank you.