Dr. Mark Fishman ’72 is the President of the Novartis Institutes for BioMedical Research, the research branch of the pharmaceutical company Novartis. Before joining Novartis in 2002, Dr. Fishman was chief of cardiology and director of the Cardiovascular Research Center at Massachusetts General Hospital, as well as a medical professor at Harvard Medical School. Reporter Clinton Wang talked to Fishman about his transition from clinical practice to the pharmaceutical industry, and how he sought to bring a stronger medical focus to the drug discovery process.
How did you go from being a physician to leading a pharmaceutical company?
My move from academia to Novartis was not my anticipated trajectory. At the time, I was at Mass General. Things were really going in about as positive a fashion as one could hope for. I was well supported, I ran the clinical service in cardiology, I ran a new institute there — the Cardiovascular Research Center — which I had founded, and we were doing work in the developmental biology and genetics of the developing embryo using zebrafish.
So there was very little reason for me to consider moving at the time, and I had very little contact with pharmaceutical companies. I was actually quite suspicious when I got a call out of the blue from them asking if I wanted to run research at Novartis. I’m not sure I even really knew anything about Novartis at the time. So I said no. … Later they asked me a second time, and I said no, I wasn’t negotiating. But my son said, “you know dad, I love your zebrafish, but don’t you think it’d be more important to make medicine?” And my daughter and wife agreed with that. I started to talk to them and I decided that it was pretty clear that if you really wanted to have a big impact on medicine, that’s how you do it, discover new medicine. So that’s why I moved over.
What kind of changes did you make to the company?
When I started, there were no physicians involved. And I felt it was important for physicians to be involved early on so that we know whatever we’re studying has a clinical foundation. So people are judged for quality of their science, not for some arbitrary numerical evaluation that you’d typically use in a company. The idea of moving from financially driven decision-making to medical decision-making has been a big change but quite productive. It’s now accepted throughout the entire company.
We took the company into new directions, such as a focus on rare diseases. Many rare diseases are quite well understood and it’s feasible to make drugs for them, but historically they’re not the focus of pharmaceuticals because they don’t have many patients so they aren’t profitable. But the advantage of working on a rare disease is we can usually get an answer quickly, and we learn that in many cases, the mechanisms that drive rare diseases are related to the mechanisms that drive more complex disease.
How do you stay profitable when you prioritize clinical importance over financial considerations?
We’re not only focused on rare diseases, we’re looking at fundamental mechanisms that underlie common diseases like heart failure. By moving away from portfolios that rely on big blockbuster drugs, we’re able to make money from a range of sources. But at the end of the day, the more innovative your medicine is, the better off your company will be.
And many companies now are quite desperate. The number of drugs has been fairly stable last year but by and large it hasn’t been not a lot. You have 20-25 new drugs a year approved by the FDA, and only a small subset — 7 or so — are truly new medicines. So there are signs of anxiety from many pharmaceutical companies. They’re lurching around, thinking that they can find something quickly. But long-term success is going to depend on those who are willing to commit to science and medicine over financial pressure, because drug discovery is a long and hard process.
How do you expect technology to transform drug discovery in the future?
Never put your faith in technology. Technology alone has never changed science without an interesting idea. When you have technology coupled to an important question, then you can get an important answer. But most of the technology that’s changed drug discovery has evolved over many years. The monoclonal antibody approach languished for many years as an interesting immunological approach before it was eventually worked out. Atomic spectroscopy, mass spec, all of these were major influences, but if you look at the number of new drugs per year over the last 20 years, there wasn’t even a blip, even after, for example, the first sequence of the human genome project, which people said would transform drug discovery.
Clinton Wang is a sophomore in Davenport College.