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be one. A main component of all five horsemen, and thus a logical target of first attack, is that of human capital. Much has been written around the importance of employee engagement, happiness and a sense of value, and how these underlie the success, innovation and longevity of business. To be sure, companies that learn, that use ‘tools for foresight,’ that have a persona (identity), that are able to continuously evolve, and that recognise that being brain-rich (versus capital-rich) are the most likely to survive54,55. These types of compa- nies are termed ‘living companies’ – an appropriate metaphor to be considered in the current perspec- tive. Individuals in the organisation could be con- sidered the cells of the company, each operating individually, with their own ‘genetic makeup’ but intimately connected to the whole. The individuals, their local networks, and wider function in the business ‘corpus’ can be influenced dramatically, if not controlled outright, by the five horsemen. For example, people are usually rather resistant to change, they operate/act in irreversible and alinear manners, they nearly always consider their own point of view as important, and want their life’s story to be heard. Guiding them individually (as a cell), as well as en masse (as a collective body), might best be done more along evolutionary (extended timelines with multiple small step changes) or along habit-inducing time lines sug- gested in de Geus’ landmark book54? How to expand the efforts beyond human resource battleground is less clear but should involve careful discussion before any action. Conversations should be held among previously identified key customer, stakeholder and content expert groups previously identified by others. For example, the pharmaceutical industry is among the most regulated of industries and national and international regulatory bodies (FDA, EMEA, etc) are well-known to be the major drivers of clinical trial design and interpretation. There is, thus, a tremendous opportunity for health authorities to establish a regulatory environment where the industry is able to adopt new value propositions in the drug development operating model (such as the use of drug prototypes56). Additional example areas that might serve as starting points include: novel drug research models to maximally incorpo- rate network pharmacology/systems biology approaches that look beyond the ‘one target one clinical endpoint’ paradigm; regulatory authorities taking a more ‘holistic’ approach to study execu- tion guidelines and regulatory approval processes; payer organisations approaching healthcare reim- bursement from a ‘narrative medicine’ perspective;
Drug Discovery World Winter 2011/12
and a healthcare delivery system that addresses patient care differences based on their individual circumstances throughout their ‘evolutionary dis- ease management’ lifetime.
In closing, this perspective is neither meant to be an exhaustive review of the five primary areas nor a comprehensive list of examples supporting the points. The apocalyptic horsemen myth analogy, moreover, should only be considered as one of many that could be used to help frame the neces- sary discussions around each area. Indeed, perhaps other philosophical or religious myths would help identify additional critical areas worthy of explo- ration. Regardless of the specific story chosen or characters identified, the power of futuristic stories lies not in the predicting of the eventual future, but in the crafting of multiple possible futures – a process referred to as a ‘tool for foresight’54. Through the identification of possible futures, both leaders of business and science can enhance their awareness of previously ‘unthinkable’ movements in the world that might ultimately become the major driving factors of their eventual fate. It is hopefully a good use of our time to tell the tall tales that open our minds to the possible futures that might await us as an industry, especially if we remember there are always available options of the actions we can take to help them become a reality.
Acknowledgements
The author would like to thank the following col- leagues for insightful discussion and criticism of the manuscript: James (Jim) Resch, Helen Dowden, William (Bill) Zinkand, Martin (Marty) DeBerardinis, Keith Russell and Neill H Carman.
Competing financial interest statement The author is an employee of AstraZeneca Pharmaceuticals, LLC, and owns stock in the compa- ny. The author is solely responsible for the content of the article and the conclusions drawn.
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47 Russell, CS, Clarke, LA. Clin. Genet. 1999; 55:389-394. 48 Gaide, O. Am. J. Med. Genet. 2009; 149A:2042-2044. 49 Krejsa, C, Rogge, M, Sadee, W. Nat. Rev. Drug Discov. 2006; 5:507-521. 50 Dobson, PD, Patel, Y, Kell, DB. Drug Discov. Today 2009; 14:31-40. 51 Khanna, V, Ranganathan, S. BMC Bioinformatics 2009; 10(Suppl 15):S10. 52 Clay, AS, Hainline, BE. Chest 2007; 132:1368-1378. 53 Szarc vel Szic, K, Ndlovu, MN, Haegeman, G, Berghe, WV. Biochem. Pharmacol. 2010; 80:1816-1832. 54 de Geus, AP. Harvard Business School Press 1997; ISBN 978-1-57851-820-3. 55 de Geus, AP. The Washington Quarterly 1998; 21:197-205. 56 Cohen, AF. Nat. Rev. Drug Discov. 2010; 9:856-865.
Dr Gary J. Keil is a chronic pain neuropharmacol- ogist and electrophysiologist and has worked in AstraZeneca’s discovery and pan-R&D strategy groups for the past 14 years. This work has includ- ed strategic analyses of novel sciences and tech- nologies, environmental impact assessments and organisational dynamics.
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