In European systems, it probably is as varied as the different countries are in their different approach. So this notion of who ultimately pays the bill is not a simple question to answer, is it?

Jean-Christophe Barland
No, it’s a very complex situation and actually to be complete to answer your questions about the customers, you are just introducing a very important stakeholder with the payer. And the payer could be a patient, it could be an insurance company, it could be national healthcare systems. So there is a very large range of payers and that’s one of the complexities of our industry.

Richard Owen
So we’ve got a complex definition of a customer, complex definition of a payer. And then just to set the stage, finally we’ve got regulatory. And I was always struck. I mean, once I recall we had met in one of Bristol Myers conference rooms in Paris, I think it was, and there were lawyers in the room. And I think it’s unusual to have lawyers in the conversation about customer experience programs, but it’s very commonplace in pharma because what you can do is highly controlled by the regulatory environment. So the regulators are another party in this relationship, aren’t they?

Jean-Christophe Barland
Well, would say regulators are a party in the relationship in the way that they define the framework of possible interface. And we should really consider them as co-architects of what we are doing. And that’s probably why when we interface together, you could see my legal representatives and friends because I’ve always been in the view that they should therefore be involved from the beginning of the projects to make sure that what we are constructing makes sense, and why I think it’s important for this, because at the end of the day, we are also taxpayers, right? And so we are patient taxpayers, and for some of us, we are basically involved in the business of healthcare. And I think we need to make sure that whatever we are constructing is creating value for the patient and is making a good use of taxpayer money.

So I’m not seeing the regulation and the legal framework as something negative. I think it’s actually a good thing to ensure that we keep on this magnetic north.

Richard Owen
I was going to say that I’ve been building this all up for a punchline, which is that we have customers, we have payers, we have regulators. We have a menage-à-trois, basically. I’ve been working up to that for a while.

Jean-Christophe Barland
Hahaha. I hope you won’t go into a French cliché there. I know it’s called an iconoclastic theory, but be careful.

Richard Owen
I’ve been building up to that. I’m not sure the punchline was worth the buildup. So if the complexity exists in this industry, how do we think about customer experience? I mean, I guess the big question is, does the pharmaceutical industry think of customer experience as an important variable, or is it simply too difficult to unpick in terms of all of these relationships to be something that creates important outcomes for the business?

Jean-Christophe Barland
I think that as in many situations, the glass here is half full, half empty. On the half full piece, I would say that yes, I mean the pharmaceutical industry or life science industries are like other industries. They see some positive value in making sure that customer or stakeholder experience is as positive as possible.

Now, the way it’s articulated in the pharmaceutical industry is maybe because we are mainly left-brained people and we like technology. So there is a technological bias and very often customer experience is perceived as,”Oh, is there any nice digital new venture that we could go into that could make a difference?” So it has some traction, but sometimes I think it’s missing what could be really done because at the end of the day, it’s about changing behavior and technology helps.

But this is not only about technology. You have to build the will, the understanding, and the awareness of why technology can be helpful. And you have to actually fundamentally agree on the type of behaviors you want to change.

Richard Owen
So if we think about the practitioner, the prescribing physician as a simple way of thinking about the customer, how do we want their behavior to change? Or is this about changing the fundamental relationship between the provider of the product, the pharmaceutical company, and the prescribing physician? Am I right to think of that as being the key axis for how we want to manage customer experience and how do we change it?

Jean-Christophe Barland
I would say that is ultimately maybe the end point. We want, first of all, we need to, again, be mindful of doing customer experience for good. So at the end of the day, we want the right medicine to be prescribed on the right patients for the right reasons.

And I’m going back to the ethical magnetic north that we touched upon. So that means sometimes, and often actually when the work is well done, to identify the patients who shouldn’t be on a product. So that’s a really important point. And how actually can we help in the decision process to identify these right patients?

And how then can we help on the management of these patients when the product is used? It’s really important. And the pharmaceutical manufacturer or the biotech manufacturer is the best to actually position, to actually inform the customer about the best way to use the product because of the wealth and breadth of data that we have on our own product.

Richard Owen
And I think, you know, and I obviously I have a very casual understanding of the pharmaceutical industry, but from what I, from what I remember from the companies I’ve been involved with, you know, physicians at the end of the day have… are humans. They’ve got their own profiles. You’ve got whole different classes of segments of physicians ranging from those who are extremely current on products and technology, very scientific in their approach to some that are perhaps a little more old-fashioned and are less aggressive at adopting technology.

And then of course, there’s levels of competence. And we don’t like to say it, but the reality is there’s gonna be a huge variance in competence amongst physicians. Some are going to be very good at their jobs, some are gonna be very average, and some are gonna be disappointing. And so getting to a great outcome for the patient, in some ways, it sounds to me like you’re saying the more we can take out those variables from the physician equation and try and become more scientific and more data-orientated in our approach to making sure the patient gets the right product, the right solution, the closer we’re going to get to better clinical outcomes. But at the same time, the level of trust that people have with the pharmaceutical industry is going to get in the way of that. Nobody believes that there’s no self-interest here. So I guess I’m stating the obvious here, but it’s a complicated equation to get right.

Richard Owen
Very interesting, and especially to discover that you’re what I think is often referred to as an IKEA modder, in that you’re technically painting IKEA equipment, makes you a modder. You’re in the business of modifying IKEA equipment. And that was a dimension to you I had no idea about. But I think it is a fascinating story about how in a culture like Japan where precision is valued so highly, working in processes where precision is near impossible is an enormous cultural challenge. But at end of the day, keeping an eye on the ultimate outcome, which in this instance is easy to get motivated around. We can all get excited about the idea of extending lives or saving lives. And there’s a real purpose to that work, which has to be very motivating for everyone involved.

If I step back and ask you a question about the bigger picture here, we’ve got in every developed economy, you now have an aging population, some more pronounced than others, depending on the geography. You have innovation in medicine, largely a result of success of the pharmaceutical industry, but also in other forms of medical technology industry, meaning that we can extend life even further, meaning that we can treat patients in their older years with more and more innovative and technological solutions. All that adds up to good news for the species in the sense that we’re living longer, but a cost burden.

And I saw this fascinating chart, and I think it was based on the UK, which showed the sort of net economic contribution by age of the population. So as you can imagine, when it’s kids, it’s a negative contribution: they’re consuming more than that paying in. Then you get into the earning years, you’re paying taxes, peak earning years, you’re paying more taxes. Then you sort of go into retirement and old age and the chart just drops like a stone negatively. And as you get into your eighties and even the nineties, the number, the degree of negativity and sort of economic contribution becomes massive. So we’ve got this lifetime view.

And if anything, it’s getting more pronounced in that the elderly are getting more economically expensive to support. And then you have an aging population. So the stress this is going to place on society and the pharma companies has to be profound. And the natural reaction from the population is often, well, let’s do something to cap pharma prices. Let’s find some ways to sort of fight that trend. But that’s going to be a battle we’re going to see for…

Well, I mean, I’m not sure we’re gonna see the end of it, are we?

Jean-Christophe Barland
No, you are right. you are right. Basically what you are raising as a question is healthcare utilization the best way to invest on population. And of course there are no easy answers on that. What I would say is it has to be a co-construction. So every stakeholder cannot have a selfish perspective. It has to be built around a continuous dialogue. And at the end of the day, these are societal choices. I mean, you raised the point of the aging population. I think that’s a fascinating topic. By the way, an interesting one as well in terms of geographies because everybody knows the situation about Japan and Korea, but China, this is one of their biggest problems because now they are facing the consequence of having the single child policy for decades.

Richard Owen
The Chinese have literally legislated themselves into this problem, right? For the Japanese and the Koreans, you know, it’s an inevitable consequence of the nature of their society, but the Chinese have kind of self-inflicted this.

Jean-Christophe Barland
Exactly. So when we look at aging populations, there is actually, of course, a negative side about it. Clearly, past a certain age, the health care costs increase per patient. That’s natural. But maybe we need also to have a bit of thinking as societies about, is it OK to send memos in companies when people have passed 40 years old or 45 to say, “You are now in the senior group and you should try to think about the last final chapter of your career and please register to a basically a pension retirement class.” The point is actually there is also the opportunity to keep people healthy, active for longer.

And maybe people do not have to become a burden to society past 55. And we shouldn’t actually consider that at this stage they can’t generate economic value. So they are pure cost to the health care system. So behind all this conversation, there are really strong societal choices. And I think it’s going to be the task of all governments and citizens to actually work on that together.

Richard Owen
You know, that’s a really interesting point. from the perspective of someone who is definitely not, who’s definitely past 55, and I think I can speak for all of us here, because none of us are the right side of that number. The idea that we can be making economic contributions into our 70s, into our 80s, is surely one of the ways we get out of this fix, right? And not only because it changes the curve I described in a very favorable way, but it also probably enhances life, continues to give a sense of purpose. And I was struck with this, and you’ll appreciate this as a Frenchman, with the debate in France right now over modifications to the retirement age. So, you know the French are famous but not exclusive in their perspective on retirement.

Other European countries share, to some degree or another, that perspective. But the French do sort of in some ways, I hope you would agree with this or at least not take offense at the idea that the French sort of personify this idea that retirement at a certain age is an untouchable topic because we want to spend our years beyond a certain point in leisure. And that you’re suggesting that culture is going to have to change. We’re going to have to rethink what it means to retire, perhaps.

Jean-Christophe Barland
Yes, yes. And I think without going into a deeper psychoanalysis of the French society, I think that, you know, there’s always this mechanism where you run towards something or you run to escape something. And I think one of the deeper, I would say, reasons why people are so attached to early retirement, is that they perceive the relationship with work as negative. So people are actually thinking about work toxicity. I don’t deny that for some, we are privileged because we love what we do and therefore we see a very positive balance sheet in a way.

And maybe for some people, they are in a very difficult work, they’re in a very, very difficult situation. And it’s very clear that actually when you look at life expectancy as well, people who are exposed to, I would say, a less interesting job, their life expectancy or harder job, their life expectancy is shorter. again, I don’t consider that it’s crazy to say I don’t want to retire at 65 if my life expectancy is 66.

But if you are in the 80s, I think that if you want to be active, you should be given a chance. That’s my point. I think currently, currently, it’s not the case. Ageism is rampant.

Richard Owen
Yeah, it’s a problem. Living, as you know I do, in Arizona, where there’s a significant retirement community, one of the things most striking is if you go into retail in Arizona, especially to a hardware store, for example, you go into a Home Depot, it’s often been populated by a relatively elderly group.

And you know, that interaction is important for them, but they’re also very knowledgeable. If you want to know somebody who’s going to give you the right screwdriver, it’s probably somebody in their sixties who’s been doing it, you know, and that’s a rewarding relationship for everybody, not just the customer, but the employee and the employer. And obviously that’s a very narrow view of what work looks like into your sixties, but I think that you’re right. If we can create an environment where it is appealing for people to be working in their 60s and 70s and bringing their experience, then we’re going to be beneficial for society overall. And of course, as I approach my 60th birthday, I become even more acute of that idea. So I think that’s very interesting take on it. We’re not going to solve these problems without rethinking about a structure of our lives.