Cell & Gene Therapy: Command? Consent? Collaborate!

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Novartis Oncology’s Emanuele Ostuni (lead author) and Karin Blumer draw on their experience commercialising CAR-T therapies to make the case for the myriad benefits of collaborative, as opposed to command, leadership, the impact of company and team culture on the innovation journey, and why we must not confuse collaboration with consensus.


In a recent Forbes article, Bruce Booth vividly reflects on his decades of experience in both, large pharma and biotech startup companies. His article focuses on the “hard truth of innovation”, demystifying idealistic concepts of innovation having its home in the cool and nimble cultures of biotech companies with beer taps in the kitchen corners. He surgically dissects what it take to excel in innovation, building on key criteria suggested by Gary Pisano in Harvard Business Review.

A tolerance for failure but not for incompetency (i.e. for example sloppy science). Rigorous discipline. Organizational safety complemented with rigorous candour. Collaboration with individual accountability. Last but not least, flat but strong leadership.

The article struck a string on my guitar!

Yes, innovation is anything but easy, especially in the life science business. The times when an isolated genius made a breakthrough discovery are definitely gone, nicely evidenced in the history of Nobel Laureates for Medicine and Physiology. In the first decades, the award was almost exclusively given to individuals such as Emil Behring (the first Laureate). In the 1960s, the picture changed. Since then, almost all awards went to research tandems or trios, mostly multinational, reflecting the reality of modern science.

Candour, transparency and collaboration are as important in science as they are in the business world that transforms the findings of science into broadly accessible innovation.

Moreover, (healthy) disagreement is definitely a key ingredient in the recipe for successful innovation. Science has known this since the days of Karl Popper, who introduced the concept of falsification, arguing that rather than trying to verify a hypothesis only, it also has hold up against disproval. In other words: challenging and disagreeing advances science.

Has this key concept fully arrived in the business world?

I do not have a definite answer for this. Let me share my thoughts on the relevance of company and team culture and leadership style for the innovation journey – and why one must not confuse collaboration with consensus.


Transformation of leadership styles – from command to collaborate

Two World Wars dominated the first half of the 20st century. Biomedical science and innovation took on an exponential rise, driven by breakthrough discoveries of individuals such as Alexander Fleming, whose incidental discovery of the antimicrobial effect of penicillin laid the foundation for the first mass production of a pharmaceutical in the 1940s. “Command” was the dominating leadership principle in that area. Structures in organizations often followed the logic of a military organization, even reflected in job descriptions of “chiefs” and “officers”. The number of subordinates defined a leader’s influence and power.

In the best scenario, a team’s leader was a highly experienced individual, open to input from lower ranks and determined to use his (or very rarely her) position to transfer knowledge to the team and foster the next generation of leaders. While such leaders can be open to criticism and speak, this usually has to happen behind closed doors, in one-to-one discussions and not in front of larger groups.

Like many in my generation, I witnessed this leadership style in the early days of my own career. “Command” is a principle that may have worked 60 years ago and may still work for some organizations. In our area, where success depends on multiple, highly specialized experts working seamlessly together, it became obsolete.

In the commercialization of CAR-T, over 25 different roles need to interact to deliver a single treatment to a patient. They include external collaborators (such as nurses and physicians in the treatment centers, logistic partners for the cell’s transport) and highly specialized internal experts (physicians, cell laboratory staff, quality experts…). These teams constitute an “organism” that cannot be steered in a simple, top-down way.

In the middle of the century, the theory of leadership became the subject of academic interests. The focus of good leadership turned towards task- and team-orientated approaches.[1] Gradually, the concept of “consensus” took over in society and business in most countries of the Western hemisphere.

This approach trusts that the best decisions are those on which (almost) all members of a group agree. It is an inclusive concept, giving a voice to everyone and not just the leader. By fostering an environment of multiple, potentially very different and even contradictory opinions, it leads to better discussions and can bring aspects to the surface that would not be visible in a strictly hierarchical system. However, does this approach necessarily yield great – or at least better – results?

Consensus has some intrinsic challenges. The obvious one is the time aspect. Achieving consensus takes time. A good example outside of the business world is the European Union, where discussions and debating sometimes take much more time than reality would allow. Even worse, consensus may lead to the “CYA” (cover your airs) culture Bruce Booth attributes to large corporations. Instead of pushing for bold, sometimes risky decisions, individuals may prefer to hide behind the lowest common denominator of a team’s decision. This triggers the third downside of consensus approaches – the fragmentation of responsibility. As more and more people are included in the decision-making process, it becomes ultimately almost impossible to define who is responsible for good, poor or even wrong decisions. Accountability vanishes and CYA may silently take over.

Consensus is an important concept for some larger societal issues, e.g. if minority rights need to be protected. It fails in science and innovation as it blocks bold decisions and does not work well when time is a critical factor.

To my belief, the key mistake is a confusion of consensus with collaboration.

Collaboration may lead to consensus – but it should not aim for consensus. It should aim for the best decision. Collaboration is a team-based approach where individuals are secondary to the team dynamics. In the best teams, there is a strong basis of mutual trust and all individuals – regardless of their status in the organizational hierarchy – have the ability to “leave their egos at the door” and relentlessly focus on the team’s objective. Achieving the best result in unchartered territory (such as commercializing CAR-T, where there is a lot of “never done before”) needs bold ideas and the commitment of each individual to the team’s path, even though the individual may have done it differently.

They grow best in an environment that accepts healthy disagreement. One where all team members understand that consensus is a means and not an end in itself – and a tool in a broader toolbox where it may not work in a given challenge.

Let me illustrate this with a real-life example from the CAR-T world.

In the early days of the COVID-19 pandemic, we faced very challenging situations. As airlines grounded and national borders closed, potentially life-saving CAR-T-cell shipments were stuck at airports in the middle of Europe, thousands of kilometers away from terminally ill patients in dire need of the delivery. We immediately pulled expert teams together to evaluate the best possible solution. The solutions arose from within the team and could not have been commanded from thetop down. In some cases, bold individuals agreed to take the personal risk of travelling by car across Europe to a treatment center in need of support. .

In a team that collaborates well, the role of a leader is not to mold a consensus or to take an executive decision. The leader has to unblock hurdles the team may encounter and unite the team behind the best idea or proposal – even if it comes from a junior team member or an introverted expert and even if some are in disagreement.

Such a winning team will act as one and will be a safe home for all opinions while being rigorously candid. It will tolerate failure but not incompetency. Team members will be highly disciplined. It will couple collaboration with individual accountability. Its leadership will be flat and strong and will act as a role model to leave their ego at the door – where there’s an empty basket for all egos.

It is not easy to build such a winning team. It takes time, as trust does not grow over night. When we built the European CAR-T team, we were very well aware of that and spent more than just a few days to grow together. Team trust is the fabric that keeps us together and that enables remote distributed working – our favorite team picture is the one of the “human zipper” (see header picture at top of page) during our last get-together where we focused mostly on building a winning team above and beyond a winning strategy. No strategy wins if a winning team is missing!



[1] Stogdill, R and A. E. Coons, Leader Behavior: Its Description and Measurement, 1951 

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