Sunday, January 15, 2023

Be sure to wear some flowers in your hair

A gray rain fell without ceasing on the 41st Annual JP Morgan Healthcare Conference.  People huddled in hotel doorways and waited on Ubers. The bellman offered me a plastic sleeve for my umbrella as I shook it out. “Water and marble don’t go well together,” he said. In San Francisco, we didn’t get the heavy flooding and evacuations seen in SoCal, but our phones lit up with alerts of a dangerous and life-threatening situation.

Security was heavy at the Westin St. Francis. I hadn’t picked up my badge yet, so a blazered guy with an earpiece pointed me to the side entrance, where I navigated another three security people before making it to the roped-off “presenting company check-in” section. My QR code wouldn’t scan, but the friendly young woman in a white silk top said she trusted me. She handed over my badge and lanyard and a bone-white canvas tote bag with a blue embroidered JP Morgan logo. The bag was of a heft and quality that assumed there was a decent chance that its recipient would own a matching sailboat.  

The corridors and stairways of the Westin teemed with characters who in one way or another were looking to make their fortunes in pharmaceuticals.  Tall, bearded banker bros; C-suite executives in dark suits and European eyeglasses; female buy-side analysts with blonde hair yanked straight back who looked like they spent their pre-dawn hours astride a Peloton; South Asian PhD/MBAs. The Colonial Room was SRO, so I leaned against the back wall and listened to our CEO talk about how we are transforming the practice of medicine and how our operating margin was on track to reach 32% by 2025.

I spent most of my week down the hill at the Omni, shuttling between conference rooms. The company I work for is Large Cap (nestled between between Mega Cap and Medium Cap), and as such my days were stacked with one-hour blocks of presentations from different small-to-medium biotechs looking to “partner” with us. Between two and ten people would show up for each meeting, their eagerness for partnering generally in direct proportion to the number of people there.  

In general, each of these folks was either a Science Person or a Money Person. The Science People wore clothing suggesting a teenager being dragged to a wedding. Many had one minor but unignorable physical characteristic: a wandering eye, excessive ear hair, dermatitis. The Money People clustered at both ends of the fashion spectrum, either wearing suits, or going for venture capitalist casual chic: fleece vest or quarter-zip sweater over a checked button-down shirt and high-end running shoes. On’s were in abundance. Despite being Money People, they were not necessarily slick: I observed one BD woman inspect her split ends assiduously through our entire meeting.

As they spoke to us of novel therapeutic targets and cytokines and mouse models, I would regret that I had selected English as my undergraduate major. 

“Never drive a fancy car,” a former boss once said to me, “Because we don’t want to give the impression that we are profiting off of the ill health of the American public.” I suppose it’s tempting to look at all this cynically and to disapprove of the baser desires behind it. The industry has done plenty of unsavory stuff over the years. My favorite communist podcasters would go a step further and call out the unsustainability of the entire system: look no further, they might argue, than the contrast between the bright lights, fancy presentations, and carbon footprint over at the Westin St. Francis, and the rising flood waters outside.    

I can’t argue with any of that. I also know that I’m not in a position to work for free, and I suspect you aren’t either. And despite my attempts at clever commentary above, the people I spent time last week with were not caricatures; they were intelligent people trying to do decent work. Meanwhile, people are still getting sick and dying from nasty diseases.  If, God forbid, one of our kids were to come down with one of these diseases, we would pray for someone to show up with some medicine. We can all dream of a day when our elected representatives prioritize medical research over DDG 51 Burke-class Aegis Destroyers. But in the meantime, the powerful and greedy pharmaceutical industry is our best hope. Wish them luck.