Issue Date: April 2, 2007
Reining In Diabetes
More than 80 years after Novo Nordisk first began making insulin products for diabetics, the company wants to go beyond its role as a drug supplier to play a more active part in combating a growing epidemic. The Danish firm now is attempting to galvanize a global movement to raise awareness of diabetes and tackle its growing threat.
Last month, Novo Nordisk took its first step toward this goal by assembling policy makers, health care workers, patient advocates, and government officials from around the world at its Global Changing Diabetes Leadership Forum.
The event followed a United Nations resolution in December declaring diabetes a risk to the entire world. The resolution marked the first time that the organization has recognized a noninfectious disease as a serious global threat.
"This UN resolution forever changes the diabetes landscape," said Martin Silink, president of the International Diabetes Federation, which predicts that 380 million people worldwide will have diabetes by 2025. "It is now up to the diabetes world to run with it," Silink said.
Although the conference was, for the most part, a two-day brainstorming session, Novo Nordisk made several concrete commitments aimed at reining in the epidemic. The first is the launch of the Changing Diabetes Barometer, an annual scorecard designed to keep tabs on the disease.
The barometer will track, nation-by-nation, existing diabetes action programs, or the lack thereof. It will assess how individual programs are funded, identify underlying patient statistics, and then determine "how we can break the curve," said Novo Nordisk's chief executive officer, Lars Rebien Sørensen.
Getting a handle on both the size of the threat and the needs of each country is critical. Initial studies of Denmark and Bangladesh completed in 2003 by Novo Nordisk showed dramatic differences in the way diabetes is diagnosed and treated.
Novo Nordisk is now establishing a global advisory board, and it expects to publish the first disease barometer—a baseline measurement of the epidemic—by November.
The firm's second commitment is to change its corporate culture from one focused on selling drugs to one that is oriented to caring for the patient. This shift will require new metrics for how Novo's sales organization is managed. Currently, a sales representative is judged on the number of calls he or she makes per day to key medical personnel. The average physician contact time is less than 20 minutes, and the interaction is relatively one-dimensional: The salesperson is there to talk about a product.
"This is an ineffective way of using our resources," Sørensen said. Speaking to C&EN at the diabetes forum, he noted that the new approach will be based on improving outcomes for patients. For example, rather than tracking the number of calls per day, the company will track whether doctor and patient education has decreased the number of diabetes-related complications, such as amputations or incidences of blindness.
The idea is to create a two-way street on which the health care provider can identify needs and Novo Nordisk can respond with programs and tools, including its portfolio of diabetes treatments. To help implement the plan, the company is increasing its U.S. sales force to 1,900 from 1,200.
Sørensen acknowledged that linking performance to patient outcome will be "a difficult experiment" and one that could prove risky if competitors in diabetes drugs don't follow suit. Furthermore, the company will need buy-in from patient associations, physicians, and government groups. "With the reputation the pharma industry has, it is upon us to earn their trust," he said.
New educational tactics aside, the world still needs better diabetes treatments. Novo Nordisk recently jettisoned its small-molecule drug discovery efforts in diabetes to focus on large-molecule therapeutics.
The company entered the small-molecule arena hoping to replicate the benefits of injectable biologics such as insulin with small-molecule drugs that could be taken by mouth. Novo Nordisk invested in small-molecule drug discovery for 10 years without success, Sørensen now admits.
The company is shedding its preclinical small-molecule programs, along with at least half of its 180 employees in the area. A program in glucokinase activators has already been licensed to TransTech Pharma, Novo Nordisk's research partner since 2001.
In the future, the company will focus on its roots: protein-based therapeutics. "We saw that over the next 10 to 15 years, the largest growth in diabetes care will be in the area of biologics," Sørensen said.
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