The Antidote: Inside the World of New Pharma

by Barry Werth

  Hawking was accompanied by four handlers and two physicians who laid him on the padded floor among the other fliers, guided and monitored him through eight plunges, and concluded that he was in “tremendous condition”—heart rate, blood pressure, oxygen levels all normal and perfect. “Space, here I come,” Hawking pronounced ecstatically after the flight. Boger felt much the same way.

  “Zero gravity is unlike anything you have experienced,” he blogged. “It’s not at all like cresting a hill in a fast car. It’s not at all like dropping rapidly in an elevator shaft. It’s not at all like jumping out of a plane. It’s not at all like scuba diving in blue open water. It is not at all like any of these. Imagine a dimmer switch for a room light. You glide it slowly down, and the light slowly dims. Raise it back, and the light comes back on, slowly, evenly. There are no jumps, no bumps, no stomach shifting, no wind, no resistance. The light just goes down, and then it comes back up. That’s what zero gravity feels like.”

  It was in this frame of mind that Boger consolidated his external positioning at the May BIO convention in Boston. At the annual membership meeting, he was elected chairman of the board—in effect, the industry’s face in Washington. At the same time, his efforts on Beacon Hill bore fruit. Governor Patrick—with Boger beaming at his side, rolling his right thumb and forefinger together like a safecracker—touted to thousands of conventioneers recent gains in the Massachusetts economy that helped make the state a world leader in biomedicine. With one in seven jobs in the health care sector, and with more than $2 billion annually flooding into its research hospitals and university labs from the NIH, the state was proof of the power of government-subsidized science and assembled intelligence as a platform for prosperity.

  “Within this small state,” Patrick said, “we have an extraordinary confluence of research universities, teaching hospitals, brainpower, venture capital, and a long tradition of entrepreneurialism that has helped define this economy as being fueled by innovation. We are quite simply the largest life sciences supercluster on the planet. And that is a thing to be very proud of.”

  Patrick announced the goal of a $1 billion Life Sciences Initiative: a package of seed funds, training programs, subsidies, and tax breaks to attract more private investment and jobs. Boger, a key promoter, was already lobbying legislators for its passage. Rolling up his sleeves, influencing those he needed to make things happen, he saw no distinction between his public activities and his role as CEO. “I don’t see boundaries all that clearly,” he remarked.

  Inside Vertex, Boger’s blog had the paradoxical effect of bringing his external life to everyone’s laptop just as they saw less and less of him in meetings and at beer hour. Many were thrilled by his rise, it becoming a foretaste of Vertex’s future. His fun and enjoyment were in some way an extension of them, a vindication. Yet in the labs and cubicles, some also had the feeling that they’d like to be mingling with the Patriots instead of grinding away at midnight projects. They didn’t see him driving the executive team or trying to put together the remaining pieces of an organization that within a year hoped to submit a new drug approval (NDA) application to the FDA. Boger was trying to do all that too, but he didn’t think hiring the right people was the key to sustainability; culture, and spirited citizenship, were. Boger couldn’t explain himself and made no effort to. He recalls:

  Ironically, as I got more visibility about what I was doing, people got more nervous about what I was doing. What do they think a CEO does? Go ask the CEO of any real company how much time they spend walking the factory floor. As little as it takes to take the picture for the annual report. That’s just not what a CEO does. And if he does, you’re growth bound. That’s just wrong.

  If we were going to be a major company, I needed to be the chairman of BIO. I was convinced that we were on our way, so I wanted to make sure that I was building the other piece of Vertex’s externality, which couldn’t just arrive the day the first drug arrives. So suddenly we were gonna have a community relations department and start paying attention to the place where we live and pay attention to government? You can’t turn it on like a light switch. You’ve gotta have authenticity. We needed to start building an external presence. That’s not a function that you can outsource. That’s crucial. It was very calculated.

  Garrison cochaired many Vision into Practice (VIP) teams with Murcko. Now inside Vertex, he no longer was conducting an archaeology dig but a building project, and the key was to enlist talented and exemplary people. On management, Garrison favored the notion of “positive deviance”—the idea that there are people whose uncommon but successful behaviors and strategies enable them to provide better solutions than their peers. Identify those people, make them models; there’s your varsity. Boger had told him, “It’s not about the executive team, it’s about everyone,” and so he put out a companywide email asking, “Are you a deviant, or do you know one?” He got 360 responses, a deep pool from which he recruited the leaders of the VIP teams across the sites and functions. “Mark,” he says, “is definitely a positive deviant.”

  Phase II of the vision process, EMBED, altered how management valued Vertex’s key asset: its people. Like all companies, Vertex had goals and evaluated its employees on how well they met them. But Boger saw the values as a mandate to change the company’s compensation structure. How do you recognize collaboration? Originality? Daring? Bravery? Intensity? Passion? Over the next six months, with discussion at every level of the company, Vertex linked the values to performance evaluation, thus hardwiring them to salary and incentives. Your bonus now relied as much on the way you met your goals—with what attitude and spirit—as on whether you met them. “This was huge,” Garrison says. “Now you could not achieve all your goals—which is what I believe all innovative companies should strive for, because if you get all your goals, they’re too easy. However, if your performance on the values was exemplary, you could get the highest possible compensation. By the same token, you could get all your goals but be in trouble. It really put teeth into it. We went around and made a lot of presentations about that.”

  Surely the greatest risk to Vertex, now that it looked to be on its way, was that it would stop taking the sort of risks that had propelled it all along, that it would cease rewarding those who were willing to fail for a bold idea, against bad odds, in order to come up with something useful—a better way. Boger believed that linking the values to compensation meant that the people who succeeded best in the company and set its tone in the future would bring to their jobs the same passion and sacrifice “beyond explanation” as Thomson, Murcko, and the other early torchbearers. Of everything he had set in motion so far, EMBED made him proudest, since he was confident it would guarantee—more than anything else—that the dominant Vertex phenotype would replicate for many years ahead.

  Trish Hurter was another positive deviant. With some “serious hiring,” she had built her formulation group up to thirty-five, going to dinner three nights a week with candidates, her lightning metabolism the only thing keeping her from becoming, she says, “a blimp.” An early adopter of the Vertex values and a true believer in Garrison’s mission, she had pushed the group to develop its own BHAG—Big Hairy Audacious Goal—a guiding vision of what it wanted to achieve and become. The result was an expression of Hurter’s own aspirations: “Everything that can be miniaturized, predicted, or modeled has been,” she explains. “It means there are no mysteries. One of the things people say about formulation is that it’s an art. That drives me ballistically crazy. To me, it’s science. It’s very difficult, complicated science, but it’s science, not freaking art. Nothing is black magic, like the witches and the cauldron.”

  In December Mueller had made Hurter head of pharmaceutical development, putting her in charge of everything pertaining to the physical nature of a drug substance and drug product, the manner in which both are made, and the regime by which the manufacturing process is shown to be in control. CMC, as the overall function is known, faces extreme
scrutiny by the FDA and other regulators, and Hurter’s department, now seventy people, would more than double before telaprevir could be launched.

  She took everyone off-site to develop a “pharm-dev” BHAG: “everything we want to be twenty years from now,” she told them. Garrison catalyzed the session. Phase III of the Vertex Values Process, SUSTAIN, was now under way, with the goal of putting in place a culture that was, as he says, “forever.” There had been much discussion about how to foster original ideas and help them rise through the company without being strangled by middle management. How do you originate an idea? And if you’re a supervisor and somebody brings you an idea, how do you respond? (Originator: do your homework; do feasibility studies; gather support; get people on board with you. Supervisor: be an honest sounding board; help the originator build momentum; adjust the workload to allow exploration of the new idea.) The VIP teams had recommended proposals that Garrison workshopped with task groups like Hurter’s.

  Breaking into customary small groups and using flip charts, Hurter’s team divided its goals into four categories: science; team and business processes; personal character and well-being; and prestige and reputation. What the members arrived at was an aspirational consensus: they wanted Vertex to be a standard-bearer for great research-driven drug development and manufacturing, lauded for its industry-leading precision and efficiency, done by researchers who worked hard but had fun and high integrity: “basically scientists leading full lives,” Hurter says. She and a small group distilled the daylong discussion into a paragraph, including specific language about delivering drug molecules expertly to the precise sites in the body where they are needed, and about producing the exact desired substance, whether in milligrams or metric tons, through the most advanced continuing processes.

  Garrison pressed her, as ever, to be briefer, to zero in on the singular message that would encompass “what it looks like; the top of the mountain.” He said the paragraph was a fine example of a so-called “vivid description,” but it was not a BHAG, which wraps all that you want to say into a slogan. Hurter’s group again went off-site. They talked about what they were trying to achieve; what could be embossed on a company coffee mug or T-shirt and also have the power of truth. In its earliest days, Vertex held a slogan competition for its first company T-shirt. It was won by Aldrich (“We don’t leave success to chance”), but the scientists, more grounded in the grueling realities of science, generally preferred “I’d rather be lucky than good.” A right and true message isn’t easy.

  The pharm-dev BHAG that Hurter and her group decided upon matched the larger reputational vision of the company: “Made by Vertex: the gold standard for drugs delivered right on target.” Here in a phrase was the same proud confidence that for fifty years had echoed in the words “Made by Merck.” It didn’t come from an inspirational founder or from marketing or from the ET or a consulting firm, but from the production line.

  Hurter took it and ran. Her group, with support from Murcko, began chipping away at the larger goal, doing more PK modeling to try to improve its formulations. It expanded its use of flow simulators that predicted molecular behavior in hoppers mixing thousands of kilograms of powders and compaction simulators to predict the precise physical results when Vertex was pressing pills by the millions. Working toward a final formulation of telaprevir, Hurter wanted desperately to engineer a smaller tablet and get rid of the food effect: its bioavailability, as with many drugs, dropped off on an empty stomach. For a year, she threw significant resources into doing extensive studies on five formulations, none ultimately better than in Phase II.

  She worried that Mueller would be disappointed. “I’d spent huge amounts of FTE time, my time, to get this tablet to be where I wanted it to be, and at the end of the day, it didn’t meet the goals I’d set.” Mueller backed her up, telling her, “What are you talking about? We have a Phase III, commercial, scalable tablet that matches the Phase II. This is excellent work. Perfect! Great news! You gave it your best.” He did what Boger hoped he would do: encourage Hurter to exceed herself, even if in the end she fell short. It was all in your state of mind.

  “When people take a risk and it doesn’t pay off, you’ve got to be supportive,” Hurter says. “That’s the biggest difference between Merck and here. At Merck, if you took a risk and it paid off, you were a hero. If you took a risk and it dumped on you, you were a disaster, and for the next fifteen years, your performance review reflected that. They were very unforgiving about anybody who did something that didn’t pan out. Basically people become very cautious.”

  As a student of companies and CEOs, Garrison felt as if he’d landed in Oz, crashing through from black and white to Technicolor. “The company had me,” he admits. Almost everywhere he looked, he found a hunger to invent and improve that organizations talk forever about instilling in their people, a systemization of the process of innovation that the country and the world were crying out for. And what it was, he believed, was simply attention to the nobler drives of a certain ambitious character type. Garrison:

  I was the creative director of an advertising agency and the CEO of an ad agency, and I love to tell my former colleagues that Vertex is the most creative company I’ve ever worked for. And it is, by light years. Why are they that way? Because that’s the way Josh wanted it.

  It’s what you do. The thing that Josh understands is, it’s about the people. So he would do things that most guys don’t do. He would have a lunch with every new employee. He never said the same thing twice, but he always said the same thing. The key part was: “You’re here to save the universe. Drug development stinks, we’ve got to be smarter, we’ve got to do it differently, you’ve got to have courage.” He would tell stories. He would find ways to tee this up.

  That’s how you do it. You have to put the energy into the reason for being of the company, instead of putting the energy into the financial performance of the company. Josh built the culture. He paid attention to the culture. He was fascinated with the culture. It’s the culture, stupid. That’s the difference between great companies and not-great companies.

  A degree of caution was in order. Merck, lauded for its values and vision, was one of the companies that Jim Collins, inventor of the BHAG, featured in his 1995 bestseller Built to Last. Only a dozen years had passed, half a generation, and now when great companies with promising futures were discussed, Merck wasn’t mentioned. Nor was Sears, another of Collins’s prized examples of companies that seemed to get the balance of mission and cultural identity just right. Both could well come back, but not soon, and not easily. The “secret sauce,” as Garrison called it, had curdled. In presentations to the company and to the board, he identified the cause, which he called CLCD—“Corporate Life Cycle Disease”—the self-deception, corruption, and conservatism that come with time, experience, and Wall Street’s tyrannical expectation of year-to-year growth, which is particularly trying in pharmaceuticals.

  As much as Boger was creating Vertex to last, the company was still in adolescence—still hemorrhaging $60,000 an hour—with a long way to go to launch. Whether it was a great company or even a good one had not been tested in the market. Only time would tell if, in its deepest structures, it had become the enterprise he and other Vertexians were wagering their careers trying to build.

  As strained and remote as Boger’s relations got with his board, his ties to his top executives suffered from the opposite problem: the inevitable paternalism and fractured alignment of hub-and-spoke leadership. A majority of directors now distrusted him, feeling misled. They grumbled that he withheld data and switched subjects when questions came up that he didn’t want to discuss; that he was purposefully oblique. Emmens felt a troubling “disconnect” in meetings—a palpable mutual distaste. But the ET members—Alam, Mueller, Smith, Garrison, Ken, and the others—owed Boger their positions, admired him, and were most effective only when they could enlist him on their side. They too met as a body, but if any of them had a problem, that person went
in to see Boger one-on-one, sitting across from him as he continued to work at his computer, multitasking furiously, yet outwardly as attentive and still as a stork. On the Vertex ET, the “we” in “ ‘We’ wins” was much more “I and thou,” more “imperial we” than an expression of unity and teamwork.

  In late June Vertex announced two new senior management appointments. Kurt Graves, hired as chief commercial officer and head of business development, came from Novartis, where he had launched a record nine drugs in eighteen months as chief marketing officer. “He had fantastic credentials,” Boger recalls. “He was the Novartis commercial guy who sat in on FDA phone conferences.” Still in his forties, Graves had started his career at Merck, where Roy Vagelos picked him to lead a new unit to market Prilosec, telling him, “Go build the twenty-first-century pharma company.” With a first-class strategic, business, and analytical mind, he also had the requisite deep appreciation for R&D. Several board members considered him ripe to be groomed as Boger’s successor, one of them going so far as to anoint him the “Golden Boy” in his interview—before he was offered the job. “Thanks for taking away all my leverage,” Boger recalls thinking.

  The lawyer Amit Sachdev joined to direct the company’s government affairs and public policy efforts. He arrived from BIO, where he managed the health section and the governing board. Boger didn’t want just an in-house lobbyist with strong Beltway ties, though Sachdev was surely that: a former deputy commissioner at the FDA and before that majority counsel to the Committee on Energy and Commerce in the US House, where he was responsible for bioterrorism, food safety, and environmental issues after 9/11. Boger needed a strategic-minded activist who could wake up Washington about hepatitis C and, by extension, the urgent need for telaprevir and other new drugs. Unlike those of AIDS, the dimensions and costs of the HCV epidemic remained largely beyond the ken of politicians and bureaucrats, who failed to recognize the size of the threat to public health and the nation’s unpreparedness to pay for and fix it. A kinetic figure, casual but intense, Sachdev could backslap, but first he and Boger knew he had to educate.