Mr. Pospíšil, you have quite an interesting background, with a degree in agricultural economy engineering. You eventually left the field in 1991 to consult for Lundbeck, building the business here. Can you tell our readers about the journey you have taken, from the Czech Ministry of Agriculture, to Lundbeck consultant, to managing director for Lundbeck Czech Republic?
I never worked for the Ministry itself; rather, I worked for an organization owned by the Ministry. I studied agricultural economy, but worked afterwards as a programmer and software consultant for agricultural companies. I was in this line of work until the beginning of the ‘90s. When the regime collapsed, I established my own agency for selling software, and for offering consulting services to newly established companies and other entrepreneurs.
My father-in-law is a psychiatrist. Historically, he has been one of the leading psychiatrists in the WHO. In 1991, he came to visit my wife and me, and offered my wife, who is a medical doctor, the chance to work in the pharmaceutical business. He had by chance met someone who was looking for a person to handle the business in the Czech Republic. My wife was not interested in trying her hand at the pharma industry, and wished to continue her medical practice. I, on the other hand, thought that it could be fun to try something new. 20 years later, I am still in the business!
I established Lundbeck here in the Czech Republic. I have found that managing a pharma company is less about specific medical knowledge, and more about dealing with people, and properly arranging the business, from book-keeping to visiting ministers. My background in consulting has been quite useful.
I also had a fortuitous start because of my father-in-law’s connections in the psychiatric community. At the beginning, I enlisted his help quite frequently. Today, I myself know quite a bit.
How challenging is it to build up a niche company in this highly regulated market?
At the beginning of the ‘90s, the regulation was not as tough as it is today. The first true waves of regulation—including price and reimbursement cuts—came in 1996. From this date, cuts and changes have been ongoing.
Lundbeck has original products, and they are of top quality. Hence, it is rather easy to present these products to doctors. We can really be proud of the drugs that we offer, and doctors like to speak with us, and invite us to their offices to learn about our company’s latest developments.
We really bring something new. This has facilitated our growth, despite our status as a ‘niche’ player. Lundbeck has a great reputation in the Czech Republic.
The stigmatization of mental disease has been steadily receding in the democratic Czech Republic: for instance, recently released figures from the Czech Institute of Health Statistics show that about a third more Czechs sought psychiatric help in 2010 than in 2000. However, of the 27 European Union countries, the Czech Republic still spends the least on psychiatric care, with about 4% of total health-care-sector spending allocated to this segment. As a citizen, and as head of a mental health care company, how have you seen the realities of psychiatric care evolve in this country?
The stigma certainly still exists. In fact, I believe that it still exists all over the world: even in France, it is considered somehow ‘not normal’ to be depressed.
The Czech Republic has a long history with psychiatric care. There was a deep and thorough system of psychiatry even under the Austrian empire. Many of the mental care homes that stand all over the country were built between 1900-1920. There were 15 major facilities with more than 1,000 beds. This basic foundation is still here. The number of beds has been diminished substantially, but nonetheless these homes continue to act as a framework for care in CNS and psychiatry.
When CNS drugs first came to the market during the late ´50 and ‘60s—antipsychotics, antidepressants, etc.—a system of outpatient units was developed as well.
Inpatient and outpatient care in the Czech Republic are, therefore, quite well developed. What is missing is something inbetween: community care. We have it in the country, but it is definitely not strong enough.
Not only psychiatric patients have been stigmatized in the Czech Republic, but also psychiatrists. Psychiatry was always treated as a kind of ancillary form of healthcare. Consequently, financing is inadequate. The underlying reasons are likely historical, as well: in the beginning of the ‘90s, the leaders of the psychiatric associations were perhaps not pragmatic enough. They did not fight with enough vigor during times when it was still possible to change the transforming system.
What educational efforts is the company implementing to create a better environment for mental healthcare professionals, patients, and Lundbeck’s own drugs?
Education of doctors is our basic tool. We offer many seminars yearly in the Czech Republic, not only for psychiatrists but also for neurologists and GPs. We can access GPs with our antidepressants, so for the last ten years, we have focused on advocating our drugs benefits with them as well. We offer seminars, brochures, and other educational materials.
We also have a number of programs for patients. However, patient education cannot be too direct, and promotion of particular drugs is not possible. Nonetheless, we include them in our efforts as much as possible, given our limited resources.
What about working with regulators and other relevant governmental stakeholders? Lundbeck has recently announced that it is building the ‘commercial model of the future’ in Europe. At the time of the announcement, a company spokesperson noted that the organization will increasingly begin to target government—as governments, rather than doctors, increasingly hold the key to market access.
When we need to earn money, we earn it via our drugs; when we need to prepare for earning money, we must get the drugs to the market.
The system of drug approval and reimbursement has been complicated in the Czech Republic since ‘96. From that year forward, it has not been a guarantee that your product will receive adequate reimbursement. Hence, we have to present strong pharmacoeconomic data to the authorities.
In the last years, the system became more about calculation than argumentation. If we cannot discuss the advantages of modern medicine, and we can only show numbers, our work as a psychiatric drugs company is difficult. In psychiatry, the value of drugs is based on helping scales. There are no clear-cut results—as we might see with, say, the action of antibiotics on microbes. Most psychiatric scales were developed in the ‘60s. At the time, the difference produced by new drugs was quite clear, because it was the difference between some treatment and no treatment.
The difference today between a good existing treatment and a new, innovative treatment, is much narrower, and manipulates variables that are quite complex. For instance, we can quite successfully treat a person for depression—using both old drugs and new drugs. The difference between old and new may be expressed mainly in side-effects: perhaps the old drug produces some holes in cognition, and the new one does not.
The old psychiatric scales are not built to define ‘subtle’ differences such as these. Perhaps we must develop new scales, and a new evidence-based medicine paradigm—but this is not up to the pharmaceutical industry to do. As the system stands now, however, it is challenging to demonstrate value to the payers.
Psychiatric care has great value because of its positive effects on the social care system, too. People that receive treatment for mental illnesses are able to become more highly functioning workers and members of society. Costs to the healthcare system are recouped by savings in the social care system.
Lundbeck has plans to introduce a number of new drugs into the Czech Republic. With the difficulties you mentioned of convincing the Czech payer from a pharmacoeconmic standpoint, what is your strategy for product launch?
We must find partners in the medical associations to fight for the introduction of new medicines. Doctors’ and patients´ needs will be better heard by government stakeholders than pharma companies’ needs. Doctors and patients should pull the need, rather than us pushing.
What has been your proudest achievement in your 20 years with Lundbeck Czech Republic?
The reputation of the company and its drugs.
I believe in being reliable, consistent, and open-minded. Our team shares the same philosophy, and we have likely inherited it from our roots in Denmark.