WebMD Chief Medical Officer John Whyte, MD, MPH, speaks with Elcin Barker Ergun, CEO of the Menarini Group, in Florence, Italy, about what they believe to be a new renaissance in healthcare.
This transcript has been edited for clarity.
John Whyte, MD, MPH: I'm Dr John Whyte, and you're watching Change Makers: The Future of Health. The Renaissance was a historical time of rebirth in science, art, music, and technology. It witnessed amazing advances in all of these areas. I've been wondering lately: Are we perhaps in a new renaissance in health and healthcare, particularly as it relates to diagnostics and therapeutics for cancer, heart disease, obesity, and infectious disease? My guest today believes that we indeed are. Elcin Barker Ergun is the president and CEO of the Menarini Group. I met with her at their headquarters in Florence, Italy, widely regarded to be the birthplace of the Renaissance. She shares her excitement about the role of precision medicine, particularly targeted therapies, in impacting chronic disease. She reminds us that the role of early diagnosis is a key step in the healthcare journey. I found her thoughts about the role of artificial intelligence (AI) to be both realistic and pragmatic. She explains her leadership style and how the decision-making process is often different in Europe vs other areas of the world. And, like me, she believes that we are in a new renaissance when it comes to the future of health.
Elcin, welcome to Change Makers.
Elcin Barker Ergun: Thank you so much. It's great to be here and a real pleasure.
Whyte: Here we are in Florence, birthplace of the Renaissance. Are we in a renaissance of clinical trials and research?
Barker Ergun: Absolutely. I think we're really in an era of incredible change and progress. So many things have been happening, but now they're all coming together as we go into precision medicine in a very, very determined way. It's happening in academia and the whole ecosystem, both on the diagnostic side and on the therapeutic side. So, yes, it's really a renaissance.
Whyte: I want to talk a little bit about your specific work and priorities. Before, we were talking about how here we are in Italy, the home of big cardiovascular trials, lipid-lowering agents, and novel anticoagulants. But you also have made a strong focus on oncology. Why is that?
Barker Ergun: In reality, we have not changed our focus on cardiovascular treatments. If we look at the world and mortality rates, cardiovascular diseases are still the number-one leading cause of death, John. We are the sixth biggest cardiovascular company in the world and we have every drug possible in that area. We will continue for the reason that there's still a huge unmet need in that area. We all have to put a lot of effort into bringing more products and making sure that what we have available is used in the right way in hypertension control. So now let's move into oncology. I joined Menarini as group CEO in September 2019. Even then, our owners had the vision to enter into oncology, so my coming was very much related to that. The biggest priority was to accelerate oncology and also turn our company's direction to become more and more of an innovative pharma company.
Whyte: The big talk in cancer trials is really around precision medicine. When you think about precision medicine here at Menarini, what does that mean?
Barker Ergun: This is an area that I love talking about. It takes me back to that Renaissance question you asked about our industry at the moment. When you look at all the difficult-to-treat mutations or alterations, if you look at lung cancer, we have immune-oncology, but we now have drugs for ALK, Ros, and other things. When you look at acute myeloid leukemia, today we have Flt3 inhibitors, IDH inhibitors. And when you look at breast cancer, now we have, for example, our drug in ESR mutation. But in many different areas, we also have pathways now where we're able to create drugs. So wherever you look, we are in that renaissance of targeting very difficult-to-treat mutations, and we're truly now going for personalized treatment. In Menarini's diagnostics division, one thing that our team is working on is to be able to bring for multiple myeloma (a hematologic area), instead of bone marrow biopsy, a blood test that can enable MRD [minimal residual disease]-negative monitoring with circulating tumor cells. Most of the applications today are ctDNA. But these circulating tumor cells, rare cells in the blood, can also inform us about the tumors in a complementary way.
Whyte: And that's really exciting — to be able to find these markers in the blood rather than with bone marrow biopsy or lots of imaging studies.
Barker Ergun: Because it's so invasive, you cannot repeat it. And that is what blood-based tests are giving. But for instance, the United States is a better environment today in terms of bringing blood-based testing. Typical testing is with tissue, but in many tumors — take lung or breast — there's a lot of heterogeneity. So you don't always find a homogeneous way to characterize what is really going on. So therefore, blood-based tests should be the future.
Whyte: So that is the future of cancer care. A diagnostic?
Barker Ergun: I think it's very important. Take, for instance Europe. Europe is very fragmented, and for liquid biopsy or blood-based testing, the infrastructure is very scattered in Europe. In emerging markets, China and other places, there's also tremendous work to be done before you bring your therapeutic in order to help create that testing infrastructure. So to really fuel this renaissance of innovation, I think we need to work with authorities together to accelerate the agnostic side of this equation.
Whyte: You talk a lot about innovation, so I wanted to ask: What's your perception of AI? Is it still too early? I spoke with Dr Califf at FDA and he said he expects AI to be used in the drug review process in just a few years. Where do you see all of this developing, just in the next year or two?
Barker Ergun: I'm a computer engineer myself, not a typical background for a CEO of a biopharma company. So if you ask me, my honest opinion is that we don't have a renaissance yet on AI translated into innovation. AI has really transformed in many different areas, like how it can inform us more on the discovery or research side, where processing data is very important for us. When you correct, that is the part that I would have liked to see, and I still would like to see us using it there to guide us. But in terms of reviews and things like that, like in any other area, we are increasingly using it.
Whyte: But not necessarily in protocol design.
Barker Ergun: It's not a breakthrough innovation. It's more about acceleration of clinical trials. You can also have a lot of AI on forecasting, or clinical trial efficiency, recruitment. All of those things are guiding us very well. But the breakthrough AI translation in drug discovery and research, in my opinion, is yet to come.
Whyte: Some people look at AI and think, Oh no, this is the end of civilization. They're concerned about it. And others say that this is an opportunity for tremendous innovation. Which side are you on?
Barker Ergun: I'm somewhere in between. AI will continue, John; it's extremely important. It's fascinating. It's transformational already, but we need to find a way to regulate it. We won't be able to totally regulate it because it's going to go on with tremendous speed. But we do have to find a way to protect people's rights.
Whyte: Where do you think the greatest value is?
Barker Ergun: In things like augmented reality, there's an incredible application. It suddenly gives you access to different locations. It allows you to communicate via technology in such a different way that opens up new possibilities for all of us. One part of AI, the first, translation, is about efficiency. The other is the breakthrough in drug development.
Whyte: And that's where diagnostics comes in. It sounds a little sci-fi.
Barker Ergun: Because with all of these trials, there's a lot of data out there. We talked about big data for 10 years in pharma. But what do we do with that big data? What did we translate out of all of those biomarkers? When I joined the R&D part of our industry, I realized that our R&D people, who were mostly coming from medical biology and other related fields, have their own language. I know the IT world, which has its own language too. It's not easy for these two parts to talk and to understand each other. We have to find ways that are more user-friendly to bring these groups together to really unlock the breakthrough innovations of AI.
Whyte: You've talked about how your education, your experience, and where you've lived truly gives you a global perspective, which is unique among a lot of leaders. How do you factor in the developing world and how it may afford these treatments when it has limited resources? That's with the diagnostic side as well as the therapeutic side.
Barker Ergun: We're talking about all these fascinating innovations, but at the same time, if you look at where we are and why, cardiovascular disease is still the leading cause of death — not only in emerging markets or the developing world but also in the US and Western Europe. And that has to do with the underlying issues. Obesity today is a big problem. Everywhere, it is a really big problem, and if we don't create awareness, education… New drugs are now also coming to those areas, but we also need to create or continue education and awareness in underlying things. If you consume too much sugar, it's going to affect your metabolism, but it's also going to make you more prone to cancer. So, how do we really create a more holistic way to treat diseases? We in the Western World target a drug for a specific thing. We don't always look at the holistic view. Now those concepts are coming more and more. The second part of the equation is, how do we get access to treatments?
Whyte: What most excites you about your job?
Barker Ergun: What excites me is being able to have the resources to unlock innovation to make a huge impact on patients' lives. From a leadership perspective, you can be a role model in these jobs. You want to say to the world, "Look, if I did it, you can do it." And everybody can do it, because we always talk about bias, but people like myself also show that there's also not bias. There is a system out there that also is able to bring people like myself to these positions where you can make a tremendous impact and also influence other people.
Whyte: How are you and Menarini changing the future of healthcare?
Barker Ergun: First of all, Italy in general is known as a manufacturing hub in the pharma industry, but oncology is a very competitive area. So going into this area, we want to put Italy absolutely in that center of innovation, because in Italy there are extremely good scientists. We created a portfolio in the past 3 years of three transformational drugs, and all of them (two in the hematology area) are first in class. So this is a very exciting journey for us and we're also growing our US organization. The next trend could be from the AMR, antimicrobial resistance, area. This is a very neglected area. There's now some awareness on the whole topic. We are one of the few companies that actually has a portfolio. Some of these drugs are life saving, but we don't yet have an ecosystem that is appropriately recognizing the importance of antimicrobial resistance. Every year, over 1 million people die from antimicrobial resistance. But it's not just about bringing new drugs to this area; it's also about what we can do in terms of access to these drugs.
Whyte: I want to turn to leadership, your specific leadership. Here you are, a woman running an Italian-based pharmaceutical company. That's not the norm. How is your leadership style different?
Barker Ergun: This is a very big topic, women in leadership. Let's start with the not-so-bright side of it. Menarini is a top-50 global pharma company. Besides me, only three other women are CEOs of other top-50 global pharma companies. That is a very small number. At the board level there has been progress, but at the CEO level we have not seen that progress. I think partly that has to do with the education systems in different countries, where women may not feel well empowered. When I studied computer engineering years ago, it was a 50%/50% class.
Whyte: I'm fascinated by that. You were a computer engineer. How did you move into the pharmaceutical realm? Tell us about that.
Barker Ergun: In high school, I graduated from biology, so I was always fascinated, but it took me a while to really find my passion and to move into the pharmaceutical sector. I've worked for big US technology companies. Originally, I'm from Istanbul, and many people, most women, study engineering. So in computer engineering, it was half/half, even in the 1980s. There were also some other areas, like chemical and industrial engineering, where women are the majority. I think it gives you a very good base when you don't feel different from the start. You feel like okay, man, woman — it just doesn't matter. I think that's a very important start. When I joined some companies, later on in the UK, for instance, there weren't woman engineers.
I was in the Netherlands as a software engineer and then to the UK with a top US company, and then I transitioned into a CFO role first. So I went through finance, and then I moved into general management and regional management, and leading pharma P&L. There I did a very important turn, and I believe those are areas where people — men and women, but probably more women — maybe don't take risks. When you have a large P&L in a big European company — 4 billion, 5 billion — it's a big power job. And you don't necessarily want to go to a smaller job. But our industry — in a very healthy way, in my opinion — became more innovation driven. I believe that today, to be a successful pharma CEO, you need to know innovation, in and out. You need to know how you get to that innovation from a functional perspective. The engineering gave me a very good analytical background, and I put very sound finance on top of it. But commercial is also essential, in my opinion, to run in a CEO role. I think it's critical. For our industry, R&D is extremely critical. But in terms of geographies, it's increasingly important, if you're a global CEO, to have a cultural curiosity and to be able to understand what motivates and engages each culture.
Whyte: Is the culture of leadership in Europe different from in the United States? If so, how?
Barker Ergun: It is different, John, in the sense that the US is a fast-paced culture. It's a culture that is very focused, very results-oriented. The "what" is very important in the US. In Europe, the "how" comes into the picture. And when you look at northern Europe and southern Europe, the management styles, the leadership styles are different. Northern Europe, Nordic countries, the Netherlands, Germany — these are more consensus cultures; you have to come around the table, regardless of your hierarchy, to really discuss matters and to get into an informed decision with participation of different people. In southern Europe, there's hierarchy, but relationships are important. You first have to create relationships, create trust, and then based on that, you can really work the other things: the "what" and the "how." I think that's fundamental today in global leadership, and I don't think it's about being a woman or a man; it's about truly having that appetite to learn and to have a very strong vision and ability to work together toward that vision. That's in terms of delivering the financial goals that are really important, but also having a purpose, which is very important for us in order to create a patient-centric company that is able to bring these transformational treatments to patients.
Whyte: A big part of innovation is also educating colleagues about the latest developments, and sometimes that can be challenging. There's a lot of information out there and, as you point out, we're in a renaissance. There are studies coming out all the time. How does Menarini help educate clinicians about these innovations?
Barker Ergun: That's a great question. And this is where Medscape and other CME providers come into the picture. I think you guys are doing a phenomenal job as part of this ecosystem to help us. We give grants and through that there is independent education. Within our framework we also have other opportunities to educate physicians. A conference like ASCO, for instance, offers so many different ways, because it's not only the conference itself but what you do before that conference around that, and it goes to the different parts of the US. It goes to different parts of the world. I find our world incredibly well organized, the way we are working in our ecosystem to really educate through physicians and other collaborators. Do we really always find the best way to educate patients? Well, this is a very regulated industry. So within that framework and through the patient advocacy organizations, whenever we have them as a counterpart, we do our best. There are areas that I think can improve in different parts of the world. But overall, I think it is a well-organized industry and ecosystem to really fulfill what we're doing.
Whyte: If you were not running a pharmaceutical company, what would you be doing?
Barker Ergun: I'm passionate about science and innovation. I'm somebody who's more excited about what is possible. What is breakthrough? What can we do differently? With all of these resources that we have, we can change the course of a treatment or something very important and impactful for the world. I'm an Aquarius. We are those people who want to be at the lead of the next very important thing, so I love what I'm doing. It gives me every opportunity. I consider myself very lucky, and humbled, to really be able to bring all these therapies. Possibly, it would be that I would still want to do work in other breakthrough areas, like AI, and whatever comes next.
Whyte: Thank you, Elcin.
Barker Ergun: Thank you so much for having me.
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Cite this: Change Makers: Elcin Barker Ergun of Menarini Group on Driving a New Renaissance in Healthcare - Medscape - Sep 07, 2023.
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