Originally publishing in Life Science Leader.
At what point in your life did you realize you were going to be a C-level leader?
This is the first question posed to Elizabeth (Liz) Barrett, the CEO of Novartis Oncology. The position includes responsibility for serving on the company’s 12-member executive committee, a first in a career that began back in 1984.
With a chuckle, Barrett responds to the query, “The day I became a C-level leader.”
Like many of her biopharma peers who eventually find themselves in top leadership roles, Barrett says she did not intentionally design a career path toward achieving such an aim. “Going through my career, I looked for opportunities where I would be challenged and where I felt I could have a meaningful impact,” she clarifies. And while doing just that at consumer product giants such as Kraft Foods and Johnson & Johnson, she found herself still longing for more. Observing J&J colleagues working on the company’s healthcare side of the business, Barrett determined that’s where she wanted to be. “I felt working in healthcare would provide greater meaning,” she explains. So, she set out to do what many in biopharma will tell you is nearly impossible — move from consumer to the pharma side of the business — and for her, that has made all the difference.
Getting A Biopharma Break
Prior to entering biopharma, Barrett spent nearly a decade working in consumer packaged goods while also completing an MBA in marketing. The experience put her in close contact with consumers, thereby providing her with significant insight into how people made decisions about products and brands. Having that kind of knowledge was valuable for when she eventually entered the biopharma industry, especially in the direct- to-consumer (DTC) arena where she did some patient education and patient advocacy.
At the time, prior to 1997, most pharmaceutical promotional efforts flowed through doctors in the form of detailing, sales aids, and journal advertisements. “Because of my consumer background, I already had many of the skills I needed to quickly get up to speed on the healthcare side of the business,” she explains.
Despite that skillset, she realized that since she did not have a typical biopharma pedigree, she was going to need support from someone within J&J to help her progress to a higher level. That someone was Gary Reedy (present CEO of the American Cancer Society). “I worked for him at a critical time in my career,” she recalls. “He believed in me and gave me the opportunity to run a business even though my background didn’t check all the boxes.” From Reedy, she learned many valuable lessons, many of which she continues to apply today. “For example, he taught me that if people appear to have the right skills, and you believe they can rise to the challenge, then as a leader you are obligated to give them opportunities to see what they are capable of achieving.”
As a budding biopharma business leader at J&J, Barrett’s first disease-area responsibilities included HIV and oncology. “J&J was one of the first companies to do DTC in oncology,” she explains. Working as the VP of the company’s oncology franchise, she gained a deep understanding of what a cancer diagnosis means to patients. “That’s a connection I have never lost,” she asserts. Though she admits to being fortunate to not have had cancer herself, she notes having lost several family members and close friends to the dreaded disease. According to Barrett, it is hard not to become passionate about cancer because it touches so many people.
Invigorated By A Challenge And Change
With her 13-year career at J&J progressing nicely, in 2006 she found herself seeking a new challenge, and so she left the ranks of Big Pharma to join a much smaller company, Cephalon. There she took on the role of VP and general manager of oncology. The thing is, at the time, Cephalon didn’t even have an oncology organization, despite having acquired a small oncology drug development company (i.e., Salmedix) the year prior. “When I started at Cephalon, Frank Baldino, the company’s founder and CEO, sat me down and said, ‘You’re going to be running and building this oncology business, and whether or not you are successful is up to you.’” This was very different from her experience at J&J. For starters, though she had risen to the level of VP, at J&J she was still several layers removed from top leadership. But it was different in other ways as well. “Unlike my previous experience, I had to build the unit from scratch, and I loved that sense of accountability,” she says with a smile. She also notes relishing the freedom and empowerment given by Baldino. “He was willing to let me tackle tasks in unconventional ways.”
The drug Cephalon had bought, Treanda (bendamustine hydrochloride), was still in the process of Phase 3 studies (toward U.S. approval) that wouldn’t read out for a couple of years. But it had been on the market in Europe for a while, meaning there was a non-U.S. study containing data. This made her wonder if it was possible to use this study toward gaining an earlier FDA approval in the U.S. “Since arriving, I had been building my organization, and so I began floating the idea among members of the team,” she says. According to Barrett, the consensus was that the FDA would never approve the drug using this non-U.S. study, and it would be a complete waste of time. But she persisted by saying, “Let’s give it a try anyway, because what is it going to hurt to ask?”
She took a small team to Europe to investigate. At the time, Cephalon owned only the rights to develop Treanda in the U.S., so time was of the essence. As the clinical and regulatory teams began digging into the study, they soon realized it had been conducted in a way that could meet FDA regulatory hurdles. “We came back and talked to the FDA, and they gave us approval to use the study,” she grins. Long story short, Cephalon ended up getting FDA approval of Treanda for chronic lymphocytic leukemia (March 2008) and relapsed indolent non-Hodgkin’s lymphoma (Nov. 2008), enabling the company to launch a year early. “By using this study, Treanda was not only granted an FDA priority review, but we gained an additional indication we would not have gotten otherwise,” she notes.
Barrett took away several key lessons from this experience. First, if you want people to try to do things differently, they need to know and believe that you are in it with them. “I wasn’t depending on other people to do something I wasn’t willing to be part of, and that is why it was so important that I went with them,” she clarifies. Second, there seems to be some sort of prevailing wisdom regarding the FDA, that if you ask, and they don’t agree with you, then your company is going to lose something. To alleviate this concern Barrett frequently reiterated her position that nothing would be lost by asking. Third, she says it was critical for her to demonstrate being accountable. “I told the team that if it failed, that was OK, and on me, because I was the one who came up with the idea in the first place.”
Taking On A Global Role
After nearly three years at Cephalon, Barrett returned to Big Pharma working for Pfizer as the U.S. president of the Oncology Division and then president, North America, of the Specialty Care Division. However, what she really wanted was to run a global business. “Even though I had held global roles, my boss, Geno Germano, felt I needed experience outside of the U.S.” While considering taking the position of president, Europe, she admittedly was nervous, but mostly because she would have to relocate her family to Europe. But she saw the challenge of the position itself as a great learning opportunity for her career — and one she didn’t want to pass up.
The new job involved a corporate reorganization where she was responsible for bringing three EUbased Pfizer teams together. “I’m sure the employees were thinking, ‘Who is this woman coming over from the States to run Europe?’” she laughs. As an outsider, she knew that she would need to build equity with the team, which, for her, begins with listening and not having preconceived notions about the way things “need to be.” She explains, “You can’t default to a leadership style that you have used in the past. Instead, you need to really focus on trying to deeply understand an organization — what the employees are dealing with, the environment, the business situation — and then seek to understand even more by asking questions and, again, listening hard.”
After spending a little more than a year there, she says the plan was a success. She recalls Germano saying, “We could feel the energy from what you were doing coming across the ocean.” Barrett notes that this was probably the greatest compliment she has ever received throughout her career — thus far at least.
Embracing Present-Day Challenges At Novartis
Shortly before Barrett joined Novartis earlier this year, the company had made cancer treatment history with the first-ever FDA approval for a CAR-T cell therapy treatment — Kymriah (pronounced kim-rye-ah). It was an exciting time to join the company, but as with any type of groundbreaking therapy, there are often challenges that need to be overcome along the way. “We’ve been having some variability in manufacturing,” Barrett confesses. “We use the patient’s own cells to manufacture their personalized form of Kymriah,” which makes it inherently more complex to produce when compared to other biologics. At the end of the manufacturing process, there is a level of viability (specified by the FDA) for the newly engineered cells. “What we found is that the percentage of cells considered viable upon completion of the manufacturing process, in some cases, was not high enough to meet specifications.” During clinical trials, Novartis successfully treated patients with Kymriah sometimes manufactured with lower levels of cell viability. “But as the product is FDA approved with a specified minimum level of cell viability, if the individualized treatment falls below that threshold, Novartis can’t charge for it,” she says.
Therein lies the challenge facing Barrett and the company: Does Novartis give the patient their Kymriah with cell viability below specification for free (a $373,000 to $475,000 value, depending upon the indication), or does the company make a second manufacturing attempt, which will require a second collection of a patient’s immune cells? Don’t forget that the cancer patient is only getting sicker, and the collection and manufacturing process can take between two to three weeks. Further, a second attempt still might not result in meeting the specified level of cell viability. According to Barrett, the most important thing for Novartis was ensuring patient access. “We put things in place with the FDA so that if and when we encounter a situation where a patient’s Kymriah does not meet the specified cell viability threshold, the patient can still receive it through an expanded program and perhaps benefit from it, yet won’t be charged,” she assures. “We felt this was the right thing to do, which requires being as transparent as possible, so healthcare providers and patients understand the situation.”
Barret notes that despite this present manufacturing challenge, Novartis has been able to deliver the therapy to most patients. Further, the issue seems to primarily involve production for patients with DLBCL (diffuse large B-cell lymphoma), Kymriah’s second FDA-approved indication. “Resolving this challenge is a top priority, and we are working very closely with the FDA toward getting this figured out,” she says.
The same month Barrett took the role of CEO for Novartis Oncology, she also joined Twitter with a handle of @lizforacure. Of course, many biopharma CEOs at public and private companies have Twitter profiles. Heck, even Barrett’s boss, Vas Narasimhan, CEO of Novartis, is active on the social media platform. But Barrett’s Twitter profile page is unique, especially when compared to many (if not most) of her biopharma executive peers. Here’s why. Under her picture it says, “Read more about my community guidelines,” and includes a link. If you click on the link it takes you to a two-page PDF titled, “Elizabeth Barrett’s Community Guidelines,” which spells out her approach to Twitter and LinkedIn. This was the first time I had ever seen such an approach, and so I began checking if any other biopharma execs had done something similar. And while my search wasn’t exhaustive, of 10 other biopharma CEOs, none had such guidelines in place, including her boss. I was curious to learn more about her approach to social media. Here are her responses.
Explain The Evolution Of Your Twitter Account.
This is actually my first Twitter account. When I joined the company, we talked about the things we wanted to do both internally and externally from a communication standpoint. Together we saw an opportunity to be more active in social media, and I was a willing participant. I feel it’s important as a biotech leader to be engaged in social media and talk about the changes being made that will improve a patient’s life. After all, patients use these platforms to learn and share information. People with cancer and other serious diseases want to connect with others who understand what they’re going through.
How Did You Come Up With Elizabeth Barrett’s Community Guidelines?
Being in a regulated industry, Novartis has guidelines for social media. In keeping with that theme of transparency, I felt it was important for people to understand what topics I’d be interested in, and things I could and could not speak about, as well as where they could go for certain questions (e.g., reporting an adverse event). I felt having published social media guidelines to be important not only from a regulatory standpoint, but to be clear on why I am there (i.e., my motivations), what I am doing, and what my role is on Twitter.
Are There Other Social Media Platforms You Use?
I use LinkedIn and Twitter. I don’t have a Facebook account, as I don’t have time to post whatever it is I am doing 24/7. I prefer social media platforms where I can communicate quick messages, in support of things, whether it is what we’re doing or recognizing someone. With Twitter I can reach a lot of lay people, while on LinkedIn I have access to a lot of industry leaders. To be a leader in this industry today, you must be able to communicate with people all around the world via a variety of different platforms.