By Rachel Lane
Posted April 6th, 2019
When I ask young biomedical startups "What's your value proposition?" They often respond with a generic sentiment that echoes Annie's proclamation above: "Our technology/process/platform/methodology is better than that of our competitor."
This response doesn't surprise me, but it doesn't suffice as a value proposition. Technology that's touted as simply "better" will get overlooked by stakeholders every time because this claim is temporary and not testable. Let me explain.
2. Like a good hypothesis, good value propositions are testable. Customers should be able to verify the value of new technology before they commit to partnering with or investing in it. A value proposition such as "Our Super Assay delivers the quickest results with the highest accuracy" should be backed and verified with data. The customer doesn't need to know the trade secrets that enable those competition-smashing results, but they do need to have evidence that the product will perform as expected.
Adopt a Value-Proposition Mindset from the Beginning
To position new technology for an enduring impact, value propositions must identify the unique value intrinsically associated with the innovation that resonates with the target audience. The best time to begin evaluating a new technology's value proposition is during development, when the technology can still be tweaked to provide sustained differentiation from competing products and to better meet the market need. Testable value propositions that distinctly differentiate an innovation will ensure the technology thrives into the future.
The principles of testability and differentiation are basic, but biomedical innovations exhibit unique characteristics that can make the application of these concepts difficult.
Technology-Driven Innovation Mandates Education
Value propositions fall into one of two models: they follow either a tech-push or a market-pull strategy (outlined in more detail here). Market-pull value propositions satisfy a known market deficit, making audience attraction fairly straightforward. While technological advancements may have made the new product possible, a market with knowledgeable consumers already exists. A market-pull value proposition simply notifies the target audience that a solution to their known problem is now available.
Amazon Prime is a great example of the market-pull concept: streaming TV, movies, and music; next day shipping; subscription services; and easy online price checking/comparison shopping - quite a few of us happily accept that value proposition! While technology and expert project management make these offerings possible, the audience doesn't require any education to recognize or accept these benefits. We even welcome Amazon's Alexa into our lives because of perceived life improvement, without fully recognizing the ramifications of her presence!
Tech-push value propositions - on the other hand - arise from technological advancements instead of market demand. Audiences aren't primed for the innovation and may not be aware that they need it. This audience must be convinced of their need and educated on the new technology, making buy-in much more difficult. Most biotechs must develop tech-push value propositions.
Let's look to immuno-oncology for a biotech-push value proposition. In the past, cytotoxic small molecule drugs have been the most popular anti-cancer treatments, but immuno-oncology agents that activate the immune system to fight cancer (i.e., biologics) are touted as tomorrow's solution to this ugly disease.
Unlike market-driven products, biomedical innovations aren't chosen by an intrigued audience; they're often adopted by a desperate population, like cancer patients. So is the patient really the audience that interprets the value proposition of a new biotechnology? Yes and no. The patient should certainly understand the value offered, but the patient is generally not the initial stakeholder propositioned. Multiple stakeholders invest in novel biotechnology at different stages of development. Each stakeholder deserves a unique value proposition.
The Intricacies of Multiple Audiences
Biotechnology is a complex subject that must be translated to multiple audiences, such as investors, business leaders, end users and consumers. Different pain points - the part of the current process that is problematic for the targeted audience - motivate each of these audiences, and a good value proposition will successfully address the pain point for each stakeholder. For example, when a new therapeutic is developed, the end user (i.e., the clinician) will be motivated to adopt the new technology for different reasons than the consumer (i.e., the patient). Physicians will prioritize improved workflows, while reduced cost, fewer treatments, and less severe side-effects may resonate more strongly with patients. To capture each market, biotechs must communicate a unique value proposition to individual stakeholders.
Regulatory Agencies Influence Value Propositions
Regulatory agencies influence the value proposition that biotechs can present to stakeholders, which means some of the "latest and greatest" marketing strategies can't be applied to biotechnology. In the book Play Bigger, the authors argue that successful companies "don't sell better;" they "sell us something different." Selling something "different" is challenging in biomedical industries, where the consumer looks for cures, absolute disease prevention, or significant improvements in quality of life. Different isn't enough in biotech. New biotechnology must be quantifiably, justifiably, and/or significantly better than current options. Regulatory agencies enforce these requirements, which are necessary, but sometimes slow market entry and acceptance.
Biological Variability Limits Technology
One of the most fascinating things about biomedical discovery and innovation is that it is alive and evolving. Each innovation directly begets more knowledge, leading to better technology and a more complete understanding of biology. The latest biomedical advancements respond and interact with biology as we understand it at the point of invention. However, that technology will inevitably reveal more biological nuances and intricacies, enabling us to refine our current technology and create better solutions.
By nature, biological innovations and interventions have a smaller addressable market than most nontechnical innovations. They apply to individuals with specific disease states driven by precise biological mechanisms. In addition, the high stakes of biotech - which is often addressing life or death issues - elevates the barrier to market entry. This combination of small market/high barrier to entry creates a unique scenario that is uncomfortable to investors who want to quickly and safely achieve the largest return on their investment. If researchers keep these barriers in mind while developing their technology, they can shape their innovation to circumvent or minimize these obstacles, effectively strengthening the end value proposition.
Competing Value Propositions in Biotech
Evaluating competitor value propositions can be difficult in the biomedical industry: intellectual property, trade secrets, decades of subject matter expertise, and unknown side effects can make it impossible to anticipate the total biological impact of new technology. Candid collaboration between subject matter experts who are intimately aware of the technology's pros and cons and business personnel who are experts in communicating with target audiences will propel research forward, out of the lab and into the clinic.
A Final Thought
Although biotechnology may affect a limited market, such as a specific patient population, the summed knowledge from these technological advancements and their application in the clinic affect mankind as a unified whole. Information collected from the successful development and clinical implementation of new therapeutics and diagnostics furthers our understanding of disease specifically and biology in general.
By Rachel Lane
This post was originally featured in Scientific American Observations on November 30th, 2018 and was posted on The Written Science blog December 5th, 2018.
It was my first week in the lab when I overheard those three forbidden words.
A senior investigator asked a junior scientist about his research. From my lab bench, I heard the junior scientist utter three words that would have ended the conversation in my previous career as a dietitian. “I don’t know,” he admitted.
In the clinic, telling a physician “I don’t know” exacted a high cost: his or her loss of confidence in my expertise. Once I’d uttered those words, I would have to exert much more effort regaining the physician’s confidence than I had spent losing it. Physicians relied on my nutritional expertise to ensure that patients healed quickly. “I don’t know” suggested incompetence.
But in the lab, the words “I don’t know” would often spark lively conversation that led to new ideas and fleshed out hypothetical concepts. That’s when I realized my transition from clinical dietitian to research scientist wasn’t just a change in careers: I was entering a new reality. In this reality, “I don’t know” could indicate brilliance, not incompetence, and ideas, instead of protocols, drove success.
Bridging the Gap
I welcomed these revelations but also repeatedly saw that these differences discourage collaboration between physicians and scientists, impeding the development of clinically relevant innovations. Craig Blackstone, Scientific Director of the MD/PhD Program at the National Institutes of Health, has also encountered this dilemma: “Sometimes [physicians and scientists] just don't have enough commonality in the way they approach things to even be able to talk to one another.” After defending my PhD in biochemistry and molecular biology, I wanted to make conversation between these professionals easier, so I founded The Written Science to support the translation of science into medicine.
Traditionally, physician-scientists have bridged the gap between the clinic and lab. Physician-scientists hold professional degrees related to clinical care (i.e., MD, RN, DVM, MD/PhD) but spend most of their time conducting research. Through their unique combination of clinical and research experience, they look for insight into the molecular discordance that underlies disease etiology. They convert scientific findings into clinically relevant applications and elucidate the mechanisms that cause clinical problems.
Physician-Scientists Translate Research into Clinical Innovations
The discovery of statins—a class of drugs that inhibit cholesterol production—demonstrates the special ability of physician-scientists to connect clinical dilemmas with novel biomedical discoveries. Joseph Goldstein’s experience treating patients with familial hypercholesterolemia (FH) prompted him and Michael Brown to investigate the disease’s molecular etiology during the 1970s. Together, they discovered that patients with FH lack LDL receptors and exhibit increased LDL cholesterol production. Brown and Goldstein proposed that statins may lower the cholesterol level of these patients. Subsequent studies by these two physician-scientists and other researchers confirmed the therapeutic effect of statins in FH and other patient populations. Now, statins are a regular part of clinical care and have saved millions of lives.
The statin story shows the unique ability and opportunity of physician-scientists to connect patient symptoms with biomedical treatments. A life-saving medication was discovered, thanks to the seamless flow of information between the clinic and lab.
Due to a combination of circumstances, this fluidity has diminished over time. From 1980 to 2002, the number of biomedical science doctorates increased by over 50 percent, and spending on academic research and development efforts more than doubled. During this same time period, the clinical physician workforce increased nearly twofold, but the number of physicians choosing research-oriented careers remained steady. Scientists were conducting more studies, but fewer translators were available to facilitate the flow of information between the bench and bedside.
A relative decline in the physician-scientist population threatens crosstalk between the lab and clinic. Researchers are less aware of potential clinical implications for molecular discoveries and are not privy to the clinical observations and needs that fuel clinically relevant research. The flow of information between the lab and clinic slows.
Blackstone and others worry that physician-scientists will become more scarce in the future, restricting this information stream to a trickle (see here, here, and here). With fewer physician-scientists to intercede, cultural and professional differences between physicians and researchers may compromise the flow of information between these worlds, widening the current rift.
The earliest evidence of cultural differences between basic science and clinical practice may appear at the training level: MD students and PhD candidates are visually distinguishable on university campuses. Medical students dress in business clothes, reinforcing their authority and responsibility. Grad students usually wear jeans and t-shirts. These unintentional visual cues encourage the physical separation of lab and clinic in university hallways, where interactions between future physicians and researchers should be the most accessible.
Andrew Schafer, Distinguished Professor and physician at Weill Cornell Medical College, summarizes several of the fundamental professional differences between physicians and scientists, including the following examples, in his book, The Vanishing Physician-Scientist:
Physicians seek certainty: their job and the patient’s life demand succinct, comprehensive solutions. Scientists, on the other hand, thrive on wonder and possibility. The air-tight solutions that ease a physician’s workload are dead-ends for researchers.
So, how can collaboration between these diverse worlds be improved to ensure that scientific discoveries address clinical deficits? Partnerships between physicians and scientists are an essential part of the solution. For these partnerships to be successful, information must flow freely between these professions. Modifications to traditional institutional structures, effective communication tactics, and integrated training techniques will cultivate a shared language that facilitates fluid information exchange and productive collaboration.
Redefine and Support the Physician-Scientist
Today’s physicians face different professional and personal demands and workflows than those of previous generations. For example, recent changes in institutional demands (e.g., the Affordable Care Act) have altered physician responsibilities. Blackstone believes the structure of traditional academic medical centers does not support the needs and priorities of modern physician-scientists. A fresh model for physician involvement in research may stimulate clinical innovation.
Physicians may find collaborative research with basic scientists who have complimentary expertise to be more feasible than independent efforts. Complementary partnerships between clinical physicians and lab-based scientists will fortify the connection between these worlds.
Even collaborative studies require a significant time commitment. Blackstone believes that departmental and institutional leaders can create a supportive research environment for physicians by providing financial assistance and/or reduced patient loads to those involved in scientific studies, offsetting the cost (financial and time) required for these efforts. Institutions that champion physician research fuel biomedical innovation.
Acknowledge the Difference
Successful communication is essential for physicians and scientists to collaborate productively, especially as each field’s body of knowledge grows. To improve the flow of scientific discoveries out of the lab, researchers should succinctly summarize their findings for physicians. Physicians must learn to ponder the clinical application of basic science discoveries. As these professionals honor each other’s unique realities, their conversations about the unknown will catalyze clinically relevant innovations.
Training is a prime opportunity for future physicians and scientists to develop valuable communication techniques that foster cross-profession collaboration. Modifications to established training procedures will chip away at the foundational differences between these professionals.
Medical school classes are broad and disease-based. In contrast, PhD classes are specific (i.e., molecular) and often technique-based. Cross-training would provide physicians and researchers with a common language, facilitating collaborative studies.
Some universities have already begun to cross-train PhD and MD students. An increasing number of biomedical PhD programs are intentionally exposing graduate students to clinical medicine. Problem-based learning approaches are used to nurture wonder in medical students, and some programs offer research opportunities to those who are not on the MD/PhD track, cultivating a physician workforce that appreciates and participates in research. As these students become practicing physicians and research scientists, they will share a common language that enables better communication and more productive cross-profession collaboration.
My grad school class had one MD/PhD student. Others constantly sought his insight into the clinical relevance of reported findings, which was dependably enlightening. Once, he rightly questioned the clinical validity of an ex vivo cardiovascular model that flushed fluid through the heart in the opposite direction of blood flow. This perspective encourages clinically relevant discoveries; universities should support environments where MD and PhD student interactions are the norm, not an anomaly.
Embrace the Change
Slight tweaks to traditional research structures, effective communication skills, and a more integrated training approach will empower physicians and scientists to establish successful partnerships that generate clinically relevant applications. Together, these two professions can turn scientific “I don’t knows” into transformative solutions.