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Darwin's Medicine blog

Professor Brian D Smith is an authority on the pharmaceutical industry and works at SDA Bocconi University and Hertfordshire Business School.

Certainty comes too late

In the first of a new regular column, Professor Brian D Smith points out the practical implications of an evolving pharma market
Late clock

Since I spend my academic life researching the evolution of the industry and pontificating on where it's headed, I'm often asked questions about it. One in particular crops up every time I present: “When will the changes you predict happen?” My initial answer is equally routine: “By the time you see them it will be too late to do anything about them.” 

Forgive the slightly sarcastic and unhelpful answer but I have an excuse. You see, from an academic's perspective this query commits the cardinal sin of “begging the question”. That is, the question contains an implicit premise that directly entails the answer. To be precise, the question assumes that the industry is changing at a steady pace so that, within a margin of error, we can predict what it will look like at a given future date. But who says change has to be steady? In fact, in my research area of evolutionary theory applied to industries, the opposite is likely to be true. Allow me to elaborate for a moment before I get to what this means in practice. 

Evolution, despite its common use as an antonym for revolution, does not seem to be a gradual, steady process. In evolutionary biology, the patchy fossil record prompted Niles Eldredge and Stephen Jay Gould to coin the phrase “punctuated equilibrium”: long periods of stasis interrupted by episodes of rapid change. This seems to be an important property of complex adaptive systems, of which both biological ecologies and industries like pharma are examples. What this means is that we shouldn't expect the pharma industry to change gradually at a predictable pace. Instead, we should expect it to change little or only slowly over relatively long periods and then suddenly experience spurts of quite fundamental change, probably triggered by events in the social and technological environments with which it co-evolves.

Triggers for change
Before you dismiss this as the ramblings of an academic, take a peek at the industry's history. The latter half of the 19th century and early years of the 20th saw just such a spurt as the 600-year-old apothecary business model was replaced by what we now call research-based and OTC pharmaceuticals. Smaller but still dramatic changes occurred in the 'therapeutic revolution' after World War 2, the regulatory changes of the 1960s and the advent of generics in the 1980s.  Each of these episodes was triggered by external factors in either technology, legislation, healthcare systems or similar. And if you're looking for current examples of triggers to dramatic industry change, try HTA, the internet and globalisation.

The point is that a time-travelling version of me might well have predicted those changes in advance but it would have been near impossible to predict exactly when and how fast those changes occurred. As Neils Bohr famously said, predictions are dangerous, especially about the future. He might have added that predicting the timing of change in complex adaptive systems that experience punctuated equilibrium is even more dangerous and not a little naive. 

OK. So we can dare to predict how the industry will evolve but not the timing of those changes. Does that mean we should just wait and see then adapt to the changes in the industry? No. In fact, if we use the 19th century birth of research-based pharma as an example, we can see that it was those that anticipated and pre-empted change that were most successful. That's where names like Bayer, Pfizer, Merck and GSK come from.

We shouldn't expect the pharma industry to change gradually at a predictable pace 

Build your own future
There are two reasons that 'anticipators' win over 'reactors' in the survival stakes. The first, obvious, one is that change takes time, especially in pharma, and that anticipators gain a sustainable lead. For example, when Burroughs Wellcome anticipated change by being the first to do animal studies outside a university, it seized the head start that eventually led to GSK. The second, less obvious, reason is that anticipators lead and shape change, thus building their own future. When Roche acquired Boehringer Mannheim in 1997 it shaped the diagnostic-therapeutic future. So history tells us that anticipators are likely to be the ones that are the future of pharma. And right now we can see examples of anticipation (for example, Merck's work in telemedicine) and its opposite (almost every time you see the phrase “industry best practice”).

I promised you a practical implication and so here it is for the theory of punctuated equilibrium: anticipate how the industry will evolve and proactively adapt to it, because if you wait to react you will go the way of the apothecaries. Oh, and if you “beg the question” with an academic, expect a sarcastic answer.

Article by
Professor Brian D Smith

is an authority on the pharmaceutical industry and works at SDA Bocconi University and Hertfordshire Business School. He welcomes comments and questions on this column at

31st March 2014

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