Julia Douthart: Hello, I'm Julia Douthart with Fierce Pharma. And today, I'm joined by Dr. Avi Kulkarni, Senior Vice President, Life Sciences Strategic Business Unit, at Cognizant. Avi, thank you for joining us.
Avi Kulkarni: Julia, thank you for giving me the opportunity. Thank you for inviting us. Thank you.
Julia Douthart: Before we begin, could you tell me a bit about yourself and your role at Cognizant?
Avi Kulkarni: Thanks, Julia. I'm a leader in Cognizant's Health Sciences Unit, and I wear two hats. My first hat is managing the Global Life Science accounts, such as Abbott, AbbVie, and Amgen. These are just the A's, you will notice I haven't gone past that yet. And working through our client partners that serve these biopharma clients. I'm responsible for Cognizant's P&L that rolls up through my strategic business unit and finds its way into our global P&L, and ultimately into our EPS.
The second hat is a lot more fun. I'm responsible for life sciences, industries services groups, the ISGs. And the ISGs at Cognizant are responsible for our domain-specific intellectual capital and thought leadership. And through them, we work on not just the thought capital, and the frameworks, and the papers we put out to our clients and to the market at large, but even our exciting partnerships, such as Medable and decentralized clinical trials. And we'll be talking I'm sure today about DCT. It's such an exciting topic in our space.
Julia Douthart: Cognizant has a very large global health sciences business measured in billions of dollars of annual revenue and life sciences is a very significant part of that. Could you tell us a little bit about, as a leader of the Life Sciences Business Unit at Cognizant, what are you seeing as the big issues? What's the industry facing right now?
Avi Kulkarni: Thank you, Julia. That is such a broad question and I could take it in all sorts of directions, but let me play this one straight on the fairway. Let's start with an absolute sense of, let's not just call it issues, but trends and things of great impact. The relevance of biopharma is clearly a big one that we get involved in a lot, right? So the relevance, the ability to play a role across socioeconomic issues, but in health. Whether it is diagnostics, prescription, drugs, or vaccines, the pandemic has taught us how important this industry is. And yet, at the same time this morning, I read a report that Moderna and Pfizer have already dropped in brand value in public consciousness. We worry about that because this is a critical industry for the betterment of mankind. In any case, that's a big one, how to position what we do in the right light, right?
The second, and more prosaic now, is this incredible upsurge in data that we are seeing. Data of all sorts, not just clinical and R and D data, but real world data, social media data, and putting all of this together with the right analytical constructs to actually yield insights. Everyone wants that, right? Tell me what this means. The third is, there's always been that... Everything has been about how does something influence population level diseases. And so Lipitor, a pill for all, lowers the bad cholesterol LDL, but from that movement to personalization, biomarker based identification of patients, cell and gene therapies, personal connectivity apps, people, patients are asking for me, tell me what this means for me. Can you cure my disease? Do I have to have this side effect, which is really not appropriate for me because it was at a population level?
The fourth is, driving complexity and scale in a way that makes this cost efficient. This industry grew up in a FIPCO model, fully integrated pharmaceutical company, and it's grown complex and the complexity has resulted in this average cost of drug development in excess of $2.3 billion and rising. And we need to de-complexify it. And technology is the answer to a big chunk of that. There's many more. And then lastly, I'll say, this is something we are all worrying about in facing, which is the great resignation and resourcing. Till we figure out when this music has stopped, who sits where at what price point, the minimum economic scale of this business to serve the public better, not just in developing drugs, but the right price point. We won't be able to know that. And that is a scary thing to understand at this stage in our industry's life cycle.
Julia Douthart: Can you connect some of what you just described to your own personal experiences?
Avi Kulkarni: I grew up one thing first, to be a physician, a doctor, and was exposed magically early on to the drug development business and chose instead to be a pharmacist. And while I was working on this with my family and myself, the construct I had in mind was the physician at best heals one patient at a time. Drugs can work across a multiplicity of patients. So you can get way more bang for the buck if you are in the right research program and solve the right problems. And this just felt to me like, if one was really searching for the Staff of Asclepius, it wasn't really physicians who had it. It was the drug industry that had it because of scale and scope. I got very excited that I got into the drug business and I've been in the business for 35 plus years, but it wasn't until cell and gene therapies, durable and curative therapies, that I realized that, in fact, my own development as a person in this space had come full circle.
Now we had gone from that initial end of one, which is what physicians do to drugs working across hundreds of thousands of patients, back to a drug, a cell and gene product that works for a N of one, for a patient of one. So here we are with, but now I can industrialize cell and gene and therefore work in a durable and curative fashion across a multiplicity of diseases. One last point, which is, all of this for it to be truly consistent with my own theme of... I've been doing research, I've been in business development, I've been doing management of accountants. I've been working across large teams to figure out how to commercialize drugs and how to price them right. How to do market access. All of this wouldn't work without technology working to enable this. Technology is almost like the silver bullet in this. And that to me is why Cognizant and firms like Cognizant are so important at this point in time, in the firmament of life sciences and pharmaceuticals.
Julia Douthart: Earlier, you mentioned Cognizant's role in pharma. It appears to be very broad. Can you narrow it down to one area and explain that area and how, what you do leads to a difference?
Avi Kulkarni: Let's pick decentralized clinical trials and the acronym being DCT. We know that DCT solves for many of the old issues and problems related to the conduct of clinical trials. And the old model for conducting a clinical trial was about designing a protocol, rolling it across typically academic medical centers, having PIs, principal investigators in charge, and making patients go to that medical center first to enroll, then to get treated, and then to do monitoring. And there's all kinds of problems with that model. Patients have had to travel hundreds of miles to take part in the clinical study. They would often not have enough time to understand all the nuances of what that study would involve. You are in this strange place, you have a bunch of white coats around you giving you guidance and counsel, and you're being asked if you'll enroll. That made it hard.
The monitoring, the after treatment follow up was also quite onerous. And this resulted not just in patient inconvenience, but in a giant Hawthorne effect where the experiment itself overcame its parameters, overcame some of the natural real world conditions we should be testing for. Decentralized clinical trials, in which we change this model and say, how can we enroll the patient as proximal to their home? How can we have treatment we deliver with the locus again, being the patient's natural rhythm, home, or work or something that's convenient, and monitor, and sometimes monitor remotely? Such as via Apple watches or the right kinds of heart bands, that allows us to change this dynamic, not just in terms of convenience. And so we end up now with better enrollment, end up with better data. Very importantly, we also end up being able to do much better and faster and cheaper clinical trial conduct than we could have in the old days.
And now what Cognizant does in this is absolutely end to end. We're involved in everything from search engine optimization and social media examination, to be able to identify patients who have self-identified what their interests are. Recruitment is easier and faster. That also has a role in retention of patients in long term clinical studies. We have technology platforms. Some that we build some that we partner with that make it seamlessly and easy for patients to participate in clinical studies and for sponsors, the pharma companies for the providers, the physicians and nurses who are part of this, to work across this milieu in a easy fashion, in an effortless fashion. And that's again, why Cognizant shines.
Just one last point, we couldn't do it ourselves. There's no one firm, which if they pumped their chest and said, I can do it all, would be speaking truthfully. The best part of what we do in this narrow case of DCT is identifying a whole milieu of partners that we work with. What the pharma sponsors, or conducting clinical studies, get to see is a seamless one stop shop, where all the webbing is appropriate and that's all that patients in the end care about. They don't need to know how many satellites were involved in their cell phone signal. Just that the signal was absolutely clear and connectivity was fast. And that's how we've been able to make DCT work across our industry.
Julia Douthart: You've been in this space for quite a while, since 1985, not that long, 1985. What would your message be? And to whom would you give it?
Avi Kulkarni: Thank you, Julia. I would like to speak to the students of today, which means folks who are in their late teens and early twenties, and I'd like them to consider how they can have a meaningful career, make an impact, serve their conscience, even as they feel the push and pull of the world. The world of biopharma is magical. While we have made amazing progress and have changed the course of many diseases and therefore, mankind, we are somewhat like Isaac Newton, who said, "I do not know what I may appear to the world, but to myself, I seem to be a small school boy on distal shores, picking seashells marveling at them. But the whole ocean of truth lies undiscovered all around me." That is pharma today, right? No matter what your functional passion, be it biology, chemistry, engineering, social sciences, the big tent of pharma needs you.
We have many intractable problems that we continue to have that need to be solved. They need to be understood at a molecular level, at a social level. Human engineering is being plumbed to its cognitive depths and social and economic policy is critical to completing the story of a successful pharma. The great debates of today, privacy, pricing, re-engineering the human body be a part of that. Join this fight. Join the firm like Cognizant. Participate in an industry that continues to shape itself and the world to its betterment.
Julia Douthart: That is a great message. I think that's a great place to close out and that's all the questions I have. Avi, thank you for joining us. I really enjoyed the conversation.
Avi Kulkarni: Thank you, Julia. Same here. Thank you so very much.
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