The Emerging Biotech Leader

At biotech companies, things often evolve at light speed, and the natural tendency of a Chief Medical Officer (CMO) can be to try and manage every detail. But it’s a superhuman task, especially when powerful egos are in play.

Show Notes

This episode of The Emerging Biotech Leader features:

Dr. Ramin Farhood, Vice President of Medical Affairs, SSI Strategy
Kim Kushner, Senior VP, SSI Strategy
Dr. Benit Maru, Senior Vice President, Medical, SSI Strategy

The team recaps Episode 1’s conversation with Dr. Suku Nagendran – President of R&D and Chief Medical Officer (CMO) at Jaguar Gene Therapy, and former CMO at Avexis, a gene therapy start-up that delivered a life-saving drug for infants suffering from Spinal Muscular Atrophy Type 1 and achieved unicorn status – about the challenges and rewards of being a CMO.

Anyone in a leadership position or who aspires to leadership will benefit from listening to the conversation.

The Takeaway:

You can’t know everything, so surround yourself with a team that can help you achieve the end goal.
Courage counts. A CMO must take charge, speak their mind, and challenge others. And be able to take the hits.
Understand the dynamics of your leadership team. People on your team don’t always know each other: their backgrounds and strengths/weaknesses. This is especially true for start-ups that are rapidly growing and evolving.
Do the right thing for your patients and your company.

Diving deeper:

A good CMO at a biotech company is like the conductor of a large orchestra; they must coordinate each section’s part in the symphony, as well as play to the

audience. The conductor can’t play every instrument, and as CMO, you need the self-awareness that you can’t do it all, so surround yourself with people with expertise in areas you don’t have. Strong leadership requires confidence, emotional maturity, and faith in the team around you.

To make the most of your resources, be resourceful. You can outsource specialized expertise to fill stopgap needs rather than onboarding new hires. Especially early on in the development process.

But perhaps the best quote is from Dr. Nagendran: ”I’m a nobody who became a somebody because of all the people around me.”

Challenges for CMOs

It’s tough to admit you need help when trying to step up and take charge. This can be more difficult for younger “up-and-comers” than more experienced CMOs.
Development timelines are truncated and complex; sometimes, expediency wins out.
Investors are looking for ROI, and startups can’t afford to fail, so a CMO must construct a rationale that speaks to the CEO, board, and investors.
You don’t always have time to consider the implications of your decisions, so you will make mistakes. But it’s better to make a few small mistakes than one big one.

What is The Emerging Biotech Leader?

Biotech—it's complicated.

A successful product launch requires grit, determination, and clear direction.

But let’s be real, the path to launch isn’t a straight one.

There are curves, hard turns, and dead ends.

Here’s the good news, you don’t have to navigate the complexities alone.

Welcome to The Emerging Biotech Leader, where we help biotech leaders maximize the value of their therapeutics from clinical development to product launch.

Welcome to The Emerging Biotech Leader,

where we help biotech leaders

maximize the value of their therapeutics

from clinical development to product launch.

We’re your hosts,

I'm Kim Kushner.

And I'm Ramin Farhood.

We are here to help

you navigate the pitfalls of the biotech industry

and illuminate the path forward.

On this episode of The Emerging Biotech Leader,

we're going to be talking about

strong leaders,

self-awareness and filling

blind spots in their own

skill sets among their team.

We recently spoke to Dr. Suku Nagendran

and we learned a lot from that conversation.

So we'll be referencing

a little bit of that today.

But we're Ramin and I are joined

by our colleague, Dr. Benit Maru

to really talk about some of the things

that we're seeing in the industry.

Before we jump

in, one of the things that Suku mentioned

that was really interesting to me

was a quote that he loves

and I personally love,

but I am probably going to butcher it.

Is around the fact that nobody

that he's a nobody,

that somebody because of the team around him

or some version of that,

which I thought was just pretty fantastic

because it says a lot about his own ego

and how he sees his team

and how he sees their ability to kind of prop up

the programs that he's worked on

and drive the overall success.

That's one piece that really stood out to me,

and that I think is really interesting for us to be thinking

about kind of across the industry

and one to posit

that as a starting point

for today's conversation.

Thanks, Kim.

I think what Suku mentioned with regards

to, you know, he is who he is

because of everyone around him.

I think that's vitally important.

And it's actually quite crucial.

I think this is one of the trends that we do see

across the biotech industry as a whole.

One of the challenges is,

is that the biotech industry is evolving so quickly.

Think about, you know, who we are in terms

of all the developments mankind has made.

But physically, you know, we're still meant to be

throwing a rock at a bigger rock in Africa,

for example, that that's kind of that piece.

And with the biotech industry

exploding as much as it has,

not everybody's going to have all the talent

that is going to be needed

for every single aspect of,

you know, a biotech development.

So understanding what it is that you need.

So, for example, Suku

mentioned on the last program

that he's not a neurologist,

he's not an expert in X, Y, Z,

but he had no problem

with surrounding himself

with people like that.

And I think that's one of the biggest things

we do see in the biotech industry at the moment,

is that people do unfortunately,

they're not able to admit

where they may need support.

And to your point,

Benit and the point Suku was making

earlier on the other episode as well.

It's it is the demand on the CMO role

and these roles in the biotech.

It's so much you almost have to be a master.

You have to be the master of the science.

You have to understand the business very well.

You have to understand the investors.

You have to understand

how to deal with the regulatory agencies,

with the opinion leaders and the thought leaders

and the patients.

So it’s almost required from you

that you are this super human being

that is able to immediately kind of pivot

from one area to the other

and you have to be excellent

and outstanding at every single one of it.

And that's almost an impossible task too.

It's a little bit unfair

what is almost demanded from these roles.

But on the other hand, well,

that’s what the job requires

and that's what you need to do to go forward.

That's why it's so important to bring the

right people on your team and get the

right folks behind you.

Yeah, it's definitely an underappreciated role in a lot of ways,

and I think one of the other things in terms

of filling out his team,

there's a really important dynamic there

in terms of the culture that they were able

to build out of AveXis as an example.

But one of the other things that

really stood out to me and is very important,

in many of the organizations

that we're working with,

as well as the dynamics

across the leadership team,

there has to be an understanding

and a patience of

what the CMO can offer at a given point in time

and the different hat

that they have to wear from moment to moment,

whether they're with their team

or whether they're with the board or an investor,

and how quickly

they have to be able to shift

in each of those changing scenarios.

So I think the leadership team dynamics is also a

really critical piece.

It's probably not as

not as well

oiled of a machine in other biotechs.

I agree, Kim.

I think that is one piece

that is vitally important

and we're all making the assumption

that all of the other senior leaders

that are part of, you know,

whichever biotech

it may be, understand this process.

At AveXis they were lucky in a way.

Suku had worked with Sean

they'd all worked with each other at varying points.

They all kind of had a sense of who they are.

That's not always the case.

At the rest of

these are the biotechs that are emerging.

People don't actually know each other.

People don't know what their strengths are,

the weakness are.

People are quite tentative

and I think that is a challenge.

And I think, you know, the value

of a chief medical officer

and a strong clinical medical department

is often under thought,

depending on

what the background of some of the other people

within that biotech are as well.

So I think that's something

that is often underplayed and the other comment

Suku made again on the last episode,

it requires courage.

It genuinely does require courage.

If you are with a group of unknowns,

you do have to be able to stand up,

you know, shoulders out to take charge.

And actually be willing to take the hits

that come back at you as well.

And I think that's something that's

that's a very rare trait, I think.

What do you think other organizations

haven't been able to crack this code?

Now, I was reflecting on this a little bit.

And, you know, is it all just ego that everyone's

a little bit too afraid

to show their own weaknesses and individuals

don't have that self-awareness

to be as open with their peers on,

I’m not strong in this area

and help me fill this gap or, you know, I'm too

afraid to show who I really am

or the questions I have

and I don't want to put that on the table.

Is it really an ego driven reason

or do you think there's something else behind it?

So Kim, I'm not so sure if it's about it's only the ego.

And ego may obviously play a part of this,

but I think it's also depending on where you are

in your career,

if you're up and coming

and a rising star in your career,

it sometimes is more challenging and difficult

to admit your weaknesses

because you're trying to establish yourself

and show the organization

that you know all of the answers

and you're in charge and

and you're leading everything true,

which obviously it's counterintuitive

because it does work against you

when things are not going so well.

I think that that's another piece of it.

But I see more and more

dealing with some of the clients

that have been in the industry for a while

that they have gotten to a point in their career

that they can easily

admit to the fact that, listen,

I’m not really good in these two or three things.

I need help in these areas.

And who are the experts

where there's outsourcing or somebody internal

that can help us out to make this happen.

And that takes another level of leadership

to be able to do that as well.

So you're suggesting it's

a little bit of like

a leadership maturity index relative

to where they are

and the time that they've had to establish

some of that self-awareness?

I do agree that it is that maturity index.

I do think that that is quite important.

I do unfortunately do think counter that.

I do think some of it is ego

based on some of the interactions

that I have had with people as well.

Some people are so scared of failure,

which is understandable.

You know, they're driven to do a certain.

You know, you go a certain way.

Some of the recent

companies that we've worked with, you know,

have spun out from well-known

academic institutes.

Now, those that are more mature

do have a better EQ.

Let's say, from a leadership

maturity perspective.

But then you've actually got others,

you know, where some people

are potentially post-docs. They're quite young.

They're quite young,

just in their career in general, regardless of it

being a biotech or not,

sometimes they face challenges in that regard.

I also think something that cannot be

and should not be overlooked

is the funding pressure.

There is such a significant funding pressure,

especially in the market today.

Everybody unfortunately is looking for

a return on investment.

Suku mentioned his philanthropic adventures,

post AveXis,

what he's been able to do because of that,

you know, he wants to do the right thing.

He wants to help make the world a better place.

Early stage companies are funded by

whomever they may be funded by,

who are looking for a return on investment

within a short period of time.

That lack of understanding of what development

is, especially in a biotech space,

causes people, in my mind to

make decisions that they probably wouldn't

do if they actually had a bit more time to think about it.

An accelerated development pipeline causes

lots and lots of challenges,

and this is where then ego and fear

all come into play.

I think so. It's so multifactorial.

And I think that last point is an important one

for us about a minute on which is the balance of

the fact that you can make the right decisions

despite needing to achieve incredibly rapid

development timelines and key milestones

for boards and investors

or whoever else you need to meet.

And I think we've all probably seen

different permutations of this, but

it's really challenging

when you have

all of these pressures

coming in with an expectation of X, Y, and Z milestone.

But as a leader, you know what your North Star is,

you know what you need to do.

And to your point, Benit,

you haven't had the opportunity to even take,

you know, 2 hours with your team

to really think through the implications

of whatever a decision might be.

So finding the balance between

maybe not taking an extended period

for development planning,

but taking a brief pause

to think about some of the implications,

and working through some of the bigger questions

that could have a longer term impact

on what you're building toward.

Agreed, and I think having

just having that time to think,

even if, again, it's not for months and months and months,

just an hour, 2 hours, just something right?

Half-day workshop max, yeah.

Exactly, I think that's helpful.

So, you know, one example of, you know, where,

you know, in not too distant past,

you know, I made a decision,

you know, as being part of a senior leader for,

you know, a company we’re supporting,

wanting to make sure

that we're doing the right thing,

we're doing the right thing

not only for the company, but for the patient.

It was a challenging development program.

Everything needed to be set up

in a stepwise manner.

The primary funders who, you know, had heavily,

heavily on the board, let's say,

push back on that.

But we stuck to our guns.

We explained to them this is what we need to do.

This is how we should do it.

We got feedback from the advocacy community.

We got feedback from regulators.

So to Suku's point, you do need courage.

You do need to be able to stick to your guns

just to show that this is the right thing to do.

What the investors

decide to do with that information

is their decision.

But I do think, you know,

as long as you can feel

that you can sleep at night.

I think another thing that you

I don't think Benit that

that you mentioned earlier

that you definitely need besides courage

beside being able to admit to your strengths

and your weaknesses is also resources.

You got to have resources

if you're in a one or two,

there's only so much you can do

and it becomes really stressful.

You've got to go really fast

and you're going to make mistakes, right?

So you really also have to be good at

pulling the narrative

and rationale together for your CEO,

for your executive team,

for the board of directors. Right?

Because, especially in a smaller

startup biotech companies,

board of directors are very much involved

with the financial decisions as well.

Resources agents and they have to buy into

why you need

a head of clinical or medical

or why you need four more people on MSL

or in operations or things like that.

And if you're also not so good

at putting those narrative

and rationale together

and being able to tie that to a business,

corporate, you know, objectives and goals,

then you're not going to get resources.

Your job becomes more frustrating.

You won't be able to meet the timeline,

and that's a challenge on its own too.

It’s not like the resources is unlimited

and is available to you

and you really have to make that case for it.

To get it.

You need to be savvy with the resources

that you can get access to and leverage

them in the most optimal way.

And Ramin,

you brought up a really good point on,

especially with limited resources,

but a smaller lean team,

you're probably going to make some mistakes.

I think we could all probably agree that

any organization

would be comfortable with a couple small mistakes

as long as you've prevented a really big mistake

or a big negative outcome. Right?

But unfortunately, the direction,

especially when we're talking about gene therapy,

specifically the direction

the industry has taken,

is that there has been

a lot of mishaps at a grander scale.

So there's absolutely some

some amount of fear at play

in terms of early decision making

because everyone's trying to avoid the

the big, big mistake, but not recognizing that

it’s okay to make tiny ones in the path

to preventing the big one. Right?

Right. Absolutely.

That is very true.

I agree. I think yeah.

I think that's it's

very important, I think of this sometimes

and this may sound daft, and I apologize,

but if you think about yourself

as a conductor of an orchestra

and you think about all the different sections,

you know, within the orchestra

with the strings, you know, percussion

and so on, when does each

section need to come into play,

you know, to create whatever,

you know, that sound that you're creating?

And that's kind of what

a CMO in this role kind of needs to be,

because you've got to especially in the gene therapy setting,

you think about the clinical piece,

the medical affairs piece, the advocacy piece,

but then you've got CMC,

you've got your product itself,

you’ve got the whole regulatory component.

Which products are you using

at which stage of development?

If you're using a normal route of administration,

there’s all device compatibility to think about.

You're going to need, you know, seasoned experts

within a certain space,

whether it may be CMC regulatory

and so on and so on.

You don't need to know

everything about gene therapy,

but you need to know about certain aspects of it.

And pulling it all together

and basically being that conductor

is challenging,

but it’s then conveying that message to the board

or an investor,

even advocacy groups as well.

Because, you know,

again, AveXis in my mind is a unique one in a sense,

because it's a devastating disease.

You know, there was no

you know, if the child can survive

beyond the age of two and a half years of age,

that's a win.

And, you know, they did that

significantly, but not all diseases are like that.

There's lots of nuance as well.

And

being able to help

explain what you're doing in simple terms

to whichever

audience it may be is another aspect

to think about as well.

That's a really great point.

I mean, having resources is one thing, right?

But also being resourceful is very important

because there are folks out there

that have exactly the resource

and the experience and the expertise

and knowledge that you're looking for.

Right?

And you can tap into those organizations

and with those outsourcing or consultants

or thought partners

that they've been there, done that,

they have that experience

and they're able to kind of fast track

and accelerate because you're kind of

getting into the collective wisdom and experience

as opposed to when you hire somebody,

you bring somebody on board.

It takes time to hire

it takes time for them fully on board

and get through the program

And that whole process

may take anywhere from six months to a year,

especially the higher the positions and the levels are.

And meanwhile, you're losing all that time, right?

Which is the investors are looking at it

the board of directors is looking at it.

So there are ways that you can kind of stop gap

and fill those needs. Right?

And it may not be just

hiring more and more people,

but that's another thing that I think

we should definitely consider.

There’s one point you made Ramin,

sorry that just triggered a memory.

Ultimately, you know, this

gene therapy, genetic medicines,

it's a novel modality.

The timelines are truncated.

You can't go into a healthy human initially.

you have to go into the disease population.

But there's also more complexity

and more pressure that's being added

because obviously there's an investor component.

There's a, you know, advocacy component.

So your traditional development

timeline is being truncated.

So not only are you truncating,

you're adding in much more complexity.

You're adding in complexity, truncation of timelines,

and, you know,

there's a desire for expediency as well.

So all of this additional challenge

that is being put forward,

that's a cross-functional problem.

That's not just with regard

to the chief medical officer, but, you know,

the companies that we've worked with,

some of them understand that,

and it's easier to work with them.

Some of them don't necessarily understand that.

And it takes us time to get them to that stage.

But every single group

that we've ended up working with and Kim,

you and I have worked on a few of them as well.

When that penny has dropped for them,

they actually understand

what we're trying to do with them and bringing

that cross-functional, cross stakeholder,

collaborative working group together,

you know, with the eyes on the prize ultimately,

which is the development of a therapy,

so then that’s beneficial for investors, advocacy,

so on and so on.

I think that's the piece that

is sometimes often

under spoken or under thought about as well.

And maybe that's a good place

to wrap today's episode,

which is really around the fact

that team dynamics would really make or break

some of the success of these programs.

It's the team dynamics and the culture that

as a leader you've built for your team,

it's how you're filling the

skill gaps across your team

to make sure that everyone can trust

that you have the right resources

and skills at the table

to really deliver against the promises

that you're making above

and below in the organization,

and that you're really driving

towards a cohesive outcome

among cross-functional leaders

that you're collaborating with

in the organization.

So with that,

thanks for the conversation today

and looking forward to our next episode.

Yeah, thanks, Kim. Thanks, Benit.

Thank you.

Thanks for tuning in to

The Emerging Biotech Leader

an SSI Strategy Podcast.

Join us each month for more

conversations with biotech leaders.

If you'd like to help navigating

the complexities of biotech,

reach out to our team at SSIStrategy.com.

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