The French President declared that he intended to make France the most welcoming and attractive place for the healthcare industry. Do you think this is possible?
Can France be the most attractive country in the world? I think the answer is certainly positive, but to say that without any further clarification would be somewhat rash. I believe France could certainly be listed among the top 3 or 5 most attractive places in the world, so my feeling is of course yes – but – it is necessary to explain why.
Firstly you have to take into account what to expect from a country considered to be attractive for foreign investment. The first point entails a welcoming environment in terms of research and industry. Secondly, the possibility of good relations via projects between the public bodies such as universities and private spheres in the industry is essential. In France the public structure of research might still be looked upon as complicated but we have two highly recognized institutions namely the INSERM and the CNRS and they create certain reference points.
At the same time, France is the number one producer of medication in Europe, and in terms of patent registration it has been an extremely important player for a long time, ranking 2nd up to 1965 – 1970, before the industry in the UK, US and Japan took off. There is also a long tradition in France linked to the quality of its medicine, and in a certain number of domains it boasts expertise and excellence of the highest quality.
So taking into account all these factors, I am convinced that this objective can be achieved. It goes without saying that a relation between saying things and putting things into practice is fundamental. The industry here has a distinct culture and way of doing things and could be interpreted differently by the US and UK, but our objective is firmly based on being able to research, improve and develop.
You refer to the different culture of doing things in the US and UK, a topic which often comes up in this area. In France, it seems like exchange between stakeholder doesn’t come naturally, and that an idea of mistrust exists. Do you feel that this is changing and is it as fast as you would like?
I would answer yes to both aspects of this question. On one hand, we are feeling the change in the world of public and private research. In the public sector, the community knows that the future is in development and innovation. In France these was a tradition of separation between the public sector and universities, and the private industry. Now the link with private industry has been fortified to the extent that they are no longer two separate worlds. After all, the majority of lab researchers in the private sector come originally from universities and the public area.
What is more important, however, are the common research programmes. The most difficult thing is that people are used to work on their own. This objective needs a real change of behaviour from Public Research and Industry. Now people are realizing that it is impossible to make it alone. A research programme may require billions and men to match, but even if you have that, it’s not enough. People need cooperation above all, with high quality researchers. We have this capability in France, and it is these links and synergies in terms of research which we need to see.
The second yes concerns the speed of the change. Although it is never as fast as we want, and it takes time to initiate projects and change people’s views, the crucial thing is achievement among the scientific community, and numerous projects are underway at this present time. Of course, the time taken between a decision and its implementation is not instantaneous, and there are some factors which block progress such as bureaucracy in France, which is well known. So why do I still say yes? Essentially, it is the increased awareness of the situation and acceleration of this which counts and through which change can be accomplished. For example, looking at the research clusters such as the Pole Medicen in Paris and the Lyon Biopole, not to mention the Pole Scientifique facility in Strasbourg, France is already boasting globally competitive research clusters with far reaching influence that did not exist a few years ago.
The forth CSIS (Conseil Stratégique des Industries de Santé) met on October 26, chaired by President Nicolas Sarkozy. How satisfied were you by the outcome?
First I have to say that at ACIP we had long been asking for such an institution that regroups all the stakeholders of the healthcare industry and services. So the very existence of the CSIS was already a victory.
There is no doubt that the CSIS meeting was significant. What is crucial about the health industry it is not solely under public control and there is a very complex balance between a typical business structure and the industrial world, from management to staff, and the traditional attachment to the public services. This is not always taken into account. Therefore it was crucial that all the key players in the public area representing the public voice such as the Minister of Health and the Minister of Research were present in order to ease the difficulties of the situation. That of course was the point originally of the CSIS and to have regular meetings.
Before the meeting took place, there were some significant expectations and I feel they were met for two reasons. Firstly, the fact the highest authority of the state was present, i.e. Nicolas Sarkozy means, above all in France, an immediate snow-ball effect on French administration. As a motor and engine to implementing change, this is absolutely essential.
Secondly, the subjects we were dealing with were not at all trivial or simply a shot in the dark but in fact dealt with a series of measures: the creation of the Conseil National des Industries de Santé has established a permanent place for exchange between the public voice and industry professionals with a key representative role for its head, aiming to take dialogue further and communicate any necessary changes and developments at all times.
Among the key priorities were innovation and support thereof. I feel though that it is necessary to expand upon this somewhat, and how to define innovation, what falls under innovation. Innovation itself must first be defined – is not as straightforward as huge revolutionary discoveries. There are also mini revolutions that happen every day. It is not just putting money and manpower behind a project and receiving immediate results to treat a given illness; the essence of innovation comes with little steps, taken frequently and working towards a result. For the public powers this is not always easy to understand, and the scientific community must work to communicate this.
The moon landing was achieved by a series of small steps over years of research and it is the same in the health industry. Alzheimer’s for example is a major problem in today’s society and will be solved with persistence and small steps, which must also be explained by the scientific community to the public powers. Although huge revolutions don’t come about every day, at the same time, significant advances can be achieved and we must ask ourselves how to fund them. This will come by dialogue between the public, economic and administrative powers with the key players in the health industry. Are we given the means to finance these small steps which are so crucial, and does the government understand this? This is what I ask myself, and leads me to think the scientific community must make this clear.
On Monday 9th November 2010, you will organize a symposium entitled ‘the health industry: a key for economic recovery’ without giving away your entire speech, could you summarize what you will intend to say ?
I will specify that it is time we stop considering health care as only expenditure and instead, first and foremost, an investment. It is about finding means to improve the health of our patients, which means as long as we view it as a secondary expenditure, we will never escape from the crisis in which we now find ourselves. This has to be at the forefront of our political strategy in France.
Innovation and research lead crucially to improvement in health, and this is what was at the forefront of my goals 10-12 years ago when requested by the government to assess the future of the health industry. Firstly, a key aim had to be a national strategy. Now, 12 years on, this is beginning to happen but we need to progress in this manner. France, with or without Europe, has achieved great things in terms of nuclear power, transport (TGV) and space, and the same could be true for the health industry. The health industry as a similar area of excellence in France should be a key priority in the future.
A cultural revolution is necessary to promote the idea that it is not expenditure, but an investment when we spend on the healthcare industry. Unprecedented debates on the “Grand Emprunt” mean that the health industry is now being taken into account in a new way. Of course, social expenditure on an industry which is there for treating patients but at the same time makes profit, means that an inherent contradiction exists within the health industry. To make sure this is no longer tenable, the issue of spending as investment must be tackled directly and made perfectly clear. People need to realize that it is spending for the benefit of us all and not for making profit which is at stake. At all steps, there are barriers and confrontation between public bodies, but at the same time the money injected must have a clear purpose and destination so that the public bodies in charge realize this.
Over the last 4 years, arguably the revolution has now begun and we may see this progression in some concrete examples. To progress in this manner, especially when you have a considerable pharmaceutical industry to work with, dialogue between the industry and public bodies must be negotiated and not forced through from a position of domination of one over the other.
In recent years, a considerable rift has emerged between the perception of the health industry, which in theory exists for the benefit of curing people, and the public, who sees it as a money making industry just as any other. Did this have an impact on leaders of the healthcare sector in France when considering their job and the relation with the public?
I would attest to the existence of a gap between medication, which is designed for the good of the public, and the controversial and sometimes negative image of the industry. The executives who work conscientiously and who are not always associated with excessive profit-making do inevitably find it difficult and sad to be associated with the excesses.
However, it is far too simplistic to lump all together and we now live in a society of defiance, and the public sometimes forget that medicine is not a simple product. They would like it to be risk free, -especially in France with the “principe de precaution”, but this cannot be the case. We cannot forget that medication necessarily involves a link between risk and benefit in our sceptical and risk free society. Essentially, the need for a drug comes about when a patient has an illness, tantamount to a customer need in any other industry. This relation between launching a product like in other industries is also key in the development of drugs, and means you cannot ignore the risk element involved. Of course, we have to minimize the risk, but to say there is no risk is simply not the case.
This intimate relation must be effectively communicated to the public, and this is often the reason why such problems exist. The situation is changing and although companies do not always hold citizens best interests highly, we cannot deny our need for healthcare companies and an industry which grows and innovates, upon which we are utterly dependent in France.
As a last message for our readers:
As for the leaders in the American market with respect to leaders in France – they may do the same job, but within contrasting environments. France’s cultural specificity and way of life means, of course, you will not find identical procedures here. The environment of business in France is something that is a reality and must be accepted within certain confines; on the contrary, the size of our market and potential here cannot be ignored either.