Ameet Nathwani, a physician, is Sanofi’s chief digital officer, chief medical officer and head of the global pharmaceutical company’s medical function. Nathwani has more than twenty years’ experience in the pharmaceutical industry, beginning in 1994 when he joined Glaxo Group Research. Between 1994 and 2004 he held increasingly senior functional and franchise leadership roles in research and development in Glaxo, SmithKline Beecham and GlaxoSmithKline, in Europe and the U.S. He joined Novartis in 2004 as Senior Vice President and Global Development Head of the Cardiovascular and Metabolic Franchise, and over an 11-year period held a number of senior development and commercial positions including Global Head of the Critical Care Franchise. Nathwani was appointed Global Head of Medical Affairs and CDO at Novartis Pharma AG and became a member of the Pharma Executive Committee, where he led the establishment of a Real World Evidence Center of Excellence and piloted its digital medicine strategy. He joined Sanofi in May 2016. Nathwani recently spoke to The Innovator about how digital is impacting healthcare and Sanofi’s own digital transformation.
Q : How is Sanofi preparing for the shift in the health care system away from products to outcomes?
A.N. : Medicine is changing dramatically because of tech. Bold companies are starting to say ‘don’t pay us for the drugs, pay us for the outcome’ Our view is let’s wait to see what is the right model. How much is a life time cure worth and how do you charge for that model ? It is very early. What is clear right now is that health care systems are struggling with costs. That is why tech is becoming so important. The cost of drugs is difficult for systems to absorb. If we can deliver therapy in a different way, if patients can be managed at home, if we can prevent expensive hospitalization, it can really help reduce healthcare costs and that is really fueling the digital explosion right now. There is more and more data available : electronic health records, data on social media, data from services like 23AndMe [a U.S. personal genomics company]. People are interested in managing their own health. At the same time doctors today are over stressed. Electronic health records are more of a burden than a benefit; they are looking at ways to improve outcomes, to keep people out of the hospital, so the whole augmentation of a physician’s decision making with data, the ability to get more insight from records and the automation of some of what they do such as reading X-rays is improving so much with technology that it is making their jobs easier. The nirvana is personalized treatment. Apart from genetic therapies that are ultra-precise, drugs today are not precise but adding technology will allow medicine to become more personalized.
Q : What sort of digital health approaches is Sanofi embracing?
A.N. : Digital therapeutics represents a new revenue stream for us and a new way of improving patient outcomes. Developing a new drug takes seven or eight years and costs around €1.6 billion and it is high risk. The time needed to develop digital therapeutics is much shorter — two or three years and a fraction of the cost. Where we can add tech around some of our products to make them more precise we are creating ‘drugs plus’ using software, hardware or digital services or all three. One example is atopic dermatitis [a chronic condition that leaves skin red and itchy]. We are testing a solution in 15 countries that can predict responses, alert patients to triggers and help them adjust their behavior. And we have a joint venture with Verily [ Alphabet, Google’s parent company’s research organization devoted to the study of life sciences] on a tech-enabled virtual healthcare system to manage diabetes at home. How much is it worth to the healthcare system if we can demonstrate that digital therapeutics saves money and save lives ? This new technology-enabled virtual way to manage diseases using AI and wearables also allows us to collect more in-depth data which can be fed into our research, give us new insights and allow us to develop new solutions.
We are also working with Google Labs on a clinical science platform that gives us a sophisticated way to manage clinical trials and use their deep AI to build predicitive models and develop better targets for our biologic drugs. And, we are using Google maps and Google search to build predictive health algorithms. By tracking the weather Google can predict which zones will have a high number of allergies. It can also track when flu season is about to hit down to a very narrow areas so we can make sure enough drugs are available. We are looking at a whole spectrum of ways that we can leverage technology and Google’s abilities in health.
Q : How do you ensure that Sanofi benefits from the data as much as Google does ?
A.N. : Google has made health one of its core missions. They already have a biotech company — Calico- and a health company Verily. So they are already in health. They are very good at the tech side of data automation, AI and deep learning. When you look at their immense computational power and what they can do in AI it is staggering. It changes science and can lead to the faster development of better medicines so why wouldn’t we partner with them ? Theoretically there is a risk of abuse when big tech companies are involved but our data is encrypted and it is HIPPA and GDPR compliant. That is a must for us. If we want to create better outcomes we can’t be scared of the tech giants.
Q : Where are you on your digital journey ?
A.N. : We are at the beginning of a journey. We just had our digital strategy approved by [Sanofi’s] executive committee in May. The strategy is built around four key pillars. Pillar one is the digital enterprise which covers everything we do -anything that drives a bottom line such as automated factories, supply chain and procurement. It also covers our clinical trial process which is deeply analog. We are looking at how we can use data and partnerships to do research that helps us find new targets and how we can use Big Data at scale. The second pillar is digital health. Can we create top line value adjacent to our normal business to create technology-enabled drugs, tech-enabled virtual health care and integrate with solution providers to create new business models ? And, we have two enabling pillars. One focuses on connecting all our data internally and our information management systems. The other is a digital literacy program that focuses on upskilling. The pharmaceutical industry is lagging five to ten years behind sectors like banking and retail so we are catching up.
Q : What do you see as Sanofi’s biggest digital transformation challenge ?
A.N.: The challenge is how do you take a monolithic 110,000 person analog company that is conservative and safety concious and turn it into a data driven company and get a ROI very quickly ? It’s a lot of work. I am partnering with our CIO to ensure that we get the investment to build the infrastructure. At the same time we need to embrace new models on how we work, new types of therapeutics and new ways of thinking . We have to have a good ROI and make the core business better but we also need to look at the bigger opportunity. We need to have more people focus on population health management and help develop the right pricing models for that. We need health insurers on-board and we need to ensure there will be trust in virtual health care.
Q: What advice do you have for the heads of innovation at big companies ?
A.N.: The key to being agile in the digital space is you need lots of ideas but you also have to be very focused and disciplined about innovation. The way we have done it here is we encourage disciplined experimentation . There is a clear methodology. When there is a digital catalyst we do a MVP [minimum viable product] and take it up to the management committee and make a decision : are we ready to scale it ? And we are going to invest yea or nay ? It sounds overcontrolling but there will be no interoperability — and limited success — if you don ‘t have full buy-in and don’t build capacities behind it. The other thing is to try and develop an ecosystem mindset. We have a partnership with Google Innovation Labs and we are putting all of our teams through the Google methodologies. It is important to remember that it is not just about products but actually changing the culture of the company and finding ways to accelerate the time it will take to get people to do things differently.