Interview: Francois Sarkozy – President, FSNB Health & Care, France

sarkoThe president and founder of FSNB Health & Care, a healthcare consultancy, discusses his motivations behind the creation of his company, as well as the challenges and opportunities the pharmaceutical industry in France faces, in the context of his extensive industry experience.

After a long and distinguished career in many different areas within the healthcare industry, you launched FSNB Health & Care, a healthcare consultancy, in September 2014. What was the vision behind this company?

Throughout my three decades of experience in the healthcare sector, I have had the privilege of working in various areas, encountering many different perspectives on healthcare. This has given me a pretty holistic view of the entire industry, especially regarding its current needs and challenges.

My primary motivation was to set up a company that responds to these needs and challenges. Things have changed within the pharmaceutical industry. I spent over 15 years in strategy consulting, and I learnt that there are two parts to it. When institutions and companies want to work with consultancies on standard issues like cost-cutting, revenue-generating, they inevitably go to the larger players. However when the work requires very niche, specific expertise, they often prefer to contract senior industry professionals. For the last couple of years, I have been approached frequently in this capacity, and I decided to create a company that responds directly to this need.

How does FSNB differentiate itself from other pharmaceutical consultancies?

My fundamental philosophy is that we must not reduce a patient to a particular disease – we must treat them as human beings. This is something that many pharmaceutical companies overlook. The patient is the end customer and ultimately everything we do must be catered to them. I wanted to be in a position not only to make strategic recommendations, which is not the toughest part, but also to be in a position to support my clients in the implementation of solutions adapted to real-world situations. For this, it is crucial to have field expertise. With FSNB, I believe I have leveraged my dual medical and business background, as well as my years of experience in hospital, industry and communication, with concrete elements of patient care, such as: patient pathways, patient segmentation and the adapting of therapies to individual patient profiles. The focus on value creation for patients, healthcare professionals and payers is critical. In addition, I also have had the chance of benefiting from a rather extensive network of dedicated and experienced industry professionals, developed over many years. I was lucky enough to collaborate with many talented decision-makers: big pharmaceutical companies, insurance companies, public institutions and associations. FSNB works with an international network of very senior project managers. Currently we have projects running in the US, and in the 5 key EU countries.

We also have a network of companies with impressive expertise in areas both complementary to and compatible with FSNB. As an illustration, we are currently working with Nextep, a specialized health economics and public affairs consultancy, on specific issues. We are also working with an online patient platform, Carenity, a sort of patient Facebook for European patients. It already has over 150,000 chronic patients, and is intended to allow patients to communicate with their peers on their conditions, medicines, and pathways. While this is immensely helpful to patients themselves because of the information and knowledge exchange, it also helps to better understand unmet needs and identify potential value creating services. Ultimately, we are committed to helping to improve patient welfare.

Can you tell more about your concept of treating patients holistically, focusing on them as individuals instead of only on their condition?

My fundamental belief is that we, the entire healthcare system, need to move from treating a disease, to managing a patient. This can only happen if there is synergy and coordination between healthcare actors, within the infrastructure of a well-organized system and established good practices. For chronic patients with multiple conditions who must see many different healthcare practitioners, it is crucial that there is smooth coordination between all of them to ensure the patient gets the best quality of care.

The Ministry of Health announced recently that they would like to move towards a policy of treating patients as close to their homes as possible, moving them out of the hospital environment. However, for this to happen, the patient needs to be educated and trained in their own care as well: they need to understand their medical treatments, the benefits and risks. Hospitals are often responsible for this education before discharging patients; unfortunately, the financial incentives for hospitals are not always adapted. A better coordination between hospital and field healthcare professionals is paramount.

Given your international experience, having spent a number of years in both the United States and France, where do you see France standing in relation to the top pharmaceutical market in the world with regards to competitiveness?

It depends on the metric we are comparing. In terms of market size, there is of course no comparison between France and the US. In terms of research environment, the US is famously a fantastic environment for innovation and research. We also have very good searchers and research institutions in France. An excellent example is what Professor David Khayat has done for oncology: the creation of the National Cancer Institute with a National Cancer Plan. Now we are a leading country for oncology especially in international clinical research. This is not such a common story. What it shows is that the problem is not with a lack of entrepreneurial potential. On the contrary, I believe we have the highest number of youth entrepreneurs in Europe, more than the UK and Germany. The critical issue is that we lack the conditions and infrastructure to facilitate the growth and cultivation of entrepreneurs. We unfortunately do not know how to grow them into successful companies. In a study I did with LEEM (the French pharmaceutical association) a couple of years ago, we found that there are many young biotech companies, but they are often too small: mono-product, mono-team, mono-value – which makes it very difficult for them to survive. Germany has done a better job in combining such companies in order to diversify risk and create synergy, which also helps them obtain more funding. In another biennial survey I conducted with LEEM, we found that the attractiveness of France for international clinical research is declining. This is a common phenomenon in Western countries; we are generally losing market share in clinical research. More support and fewer constraints are needed to support the great entrepreneurs we have in the healthcare field. I believe we also should encourage more cross industry collaboration.

Whose responsibility would you say it is to improve French competitiveness in clinical research?

One issue is institutional: I believe there are too many laws and regulations, which complicate the lives of entrepreneurs, discourage such entrepreneurial efforts or postpone the initiation of some research while we have a good level of expertise. This is one important aspect of the problem, although the situation is really improving.

There is another aspect. We have fantastic research institutes including INSERM, CNRS and Institut Pasteur, but for most researchers the real prize is not necessarily to work on a translational impetus, while it is important in driving innovation. Some researchers in public institutions tend to focus only on academic publications while the implementation of their innovations is critical for a genuine real-world impact.

What do you think is the pharmaceutical industry’s current perspective of France?

The golden age of pharma companies is over, without a doubt. What the industry needs now is visibility – crucially, around the new rules of the game: regulation, taxes, and changes to market access. A lack of clarity regarding the regulatory or tax environment is always problematic for R&D and investment.

At the same time, there is an unprecedented level of innovation reaching the market, with many significant breakthroughs, in areas such as oncology, and cardiovascular. We need to be more innovative with business and economic models, and more efficient in impacting patient pathways to help securing innovations’ value and benefit to patient.

There is a serious issue surrounding public perception. The pharmaceutical industry is seen as a “devil”. If misbehaviour occurs it needs to be sanctioned. But in my experience working at all levels of the pharmaceutical industry, ultimately, most people in this industry are very ethical and genuinely want to improve people’s lives.

We often seen key opinion leaders or physicians criticized on the media, which is unfair. One needs to bear in mind that physicians’ vocation is to help their patients including those with multiple chronic conditions who require more care. But to do this they need medical time. Time is likely to be one of the scarcest resource we have in healthcare especially with the ever-increasing administrative burden. I also believe that physicians should have a fair financial compensation. I do not believe we are there yet (EUR 23  (USD 24) for a GP consultation).

As an entrepreneur in France, what advice would you give to other young entrepreneurs today?

Believe in their project, believe in themselves. Be curious, brave, persistent, a hard worker – and above all, crazy! I think you have to be a little bit crazy to want to be an entrepreneur in a tough environment!

It is also important to consider the genuine value of their products – to always focus on the patient as the final consumer of the product. Developing partnerships is key – it is important to try to find the right partners to work with. It is difficult to work alone, as an entrepreneur. Finally, do not be afraid of failure. What I really like about the US is their attitude towards failure: to fail is not a problem; the problem is when you fail twice in the exact same way. Learn from your failures. We, as a country, need to be more proud of our entrepreneurs, and to reward those daring to take personal risks in the development of new ventures. Success should be regarded as stimulating. Many of the CEOs of French success stories have done amazing jobs as entrepreneurs. I would love to hear more of these stories.

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