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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.

Relics from the past

Terms that were once perfectly descriptive now only serve to tell us how the world has changed

As a writer, I have a penchant for words.

As a scientist, I have a preoccupation with Darwinian evolution. So, it’s not surprising that I am fascinated with the way language evolves. But this month, as I hosted an online conference, those two topics overlapped with a third passion of mine, the life sciences industry, to point to the way our business is changing. As usual, I’ll digress a little before coming back to the practical conclusion.

I’ve long been interested in those little linguistics hangovers that remind us of the past. I think it began when my Dad used to tell his impatient son to ‘hold your horses’. But I observe these etymological relics all over. My kids question why, when I want some peace, I ask them to ‘turn down’ their music. After all, they do it by sliding a finger across a screen.

They give me a perplexed look when I occasionally refer to flushing the toilet as ‘pulling the chain’. And recently I’ve noticed that there are often similar anachronisms in how we describe businesses. I still refer to my broadband provider as a phone company and I call our local convenience store the ‘corner shop’. These labels, which were once perfectly descriptive, now only serve to tell us how the world has changed.

Describing your business

The labels we use for the life sciences business are as familiar to me as my children’s names. I’d put almost all of my professional contacts who aren’t academics under ‘pharma’, ‘medtech’ or ‘diagnostics’. I recognise subcategories too, such as ‘generics’ rather than ‘research-based’ and these labels have been my functional tools for the past 40-something years. But at this conference they started to show their age. For a large proportion of the people I spoke to, none of these old labels worked very well. There were people who developed drug-delivery systems.

There were others who sold companion diagnostics. And lots and lots of people who said they were involved in ‘digital health’, although even they seemed to be a very heterogenous group. When I asked these various people which areas of business they worked in, they frequently answered with two or three sentences, just to be clear, because one or two of the old words didn’t do the job adequately.

Value orientation

Later, as I pondered the increasing obsolescence of old terms, I begin to discern both a proximate and ultimate cause. As we see every day, each successful innovation encourages another imitation while, at the same time, making the next innovation harder still.

The result is that it has become harder and harder to build a better mousetrap, or at least one that value-conscious payers will accept. As a result, pharma and other life sciences companies have increasingly shifted to a value, rather than product, orientation. And, increasingly, the only way to develop a valuable innovation is not to create a better product but to create a more valuable product combination. This is true in almost every part of our industry. Soon, dumb inhalers and injectors will be archaic. Diagnostic devices are increasingly part of the ‘internet of things’.

The future of many therapies lies in following oncology and targeting specific genotypes. And, if not genotype-specific, many treatments are guided by companion diagnostics looking for biomarkers. In chronic diseases, it is hard to find a therapy for which an enabling app is not being developed.

In oncology, CAR-T therapies involve such complex approaches that they can hardly just be called drugs anymore. Even simpler therapies are increasingly trying to add value, with drug delivery systems such as microneedle patches or nanotechnology. Stepping back from the detail of all these technologies, we can see that the need to add value, and the corresponding combination products, are respectively the ultimate and proximate reasons that the old terminology no longer fits.

Funny looks

This pattern of change in our industry has parallels in others. We still refer to ‘shipping’ things that never go near the sea, for example. We still call financial institutions ‘banks’, even when storing money is a tiny part of their role today. And we still refer to parts of the media as ‘the press’, although most of them have never seen metal type.

So, it seems likely that the terms we use to label our industry will change more slowly than the industry itself. We may still be calling companies ‘pharma’ when their gene therapies hardly count as pharmaceuticals.

I expect we will still call companies ‘diagnostics’ when their product is at least as much therapeutic. And we will probably still have a ‘medical device business’ even when their devices are nothing more than substrates for their information technology or for delivering a drug. Pharma and other industry terms may still be used but, like ‘pulling the chain’, may get you funny looks from your kids.

Professor Brian D Smith works at SDA Bocconi and the University of Hertfordshire. He is a world-recognised authority on the evolution of the life sciences industry and welcomes questions at

20th January 2021

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