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EF: You took over this position in the middle of the Pandemic. What was the mission you were given or the one you set out for yourself?

PC: I was appointed a couple of months before the first Covid cases started to appear in Singapore. Despite that, the mission was clear. Novo Nordisk has always worked in chronic therapies, especially diabetes, that is where we make a difference. Therefore, the task was to find ways to expand and reach a higher number of patients.

Globally, today there are over 450 million people with diabetes, but the number of patients that are being treated comes down dramatically. When we talk particularly about insulin therapy which is needed by most of them, Novo Nordisk provides treatment for more than 50% of the global demand, but that only accounts for about 24 million people. This is just a depiction of how difficult it is to enter this market, and that was basically the task that was set as a global mandate and the one I proposed for myself. Regarding obesity, most of the medical community recognizes it as a disease at an aggregate level but at an individual one, when it comes to policymakers, doctors, and even patients, it’s seen as a condition where someone has compulsive eating. This is probably the biggest challenge.

Because managing this disease means a huge burden on a country’s economy, we are focusing too much on prevention and neglecting those patients who are already sick. In Singapore, 1,7 million people are suffering from obesity-related issues, that’s almost 1/3 of the population.

EF: If you had to identify two big lessons learned by managing through this time, what would they be?

PC: I think the biggest learning has been realizing the vulnerability of the system. Even though every stakeholder in the system is aligned and puts in efforts to perfect its functioning, we can’t change the fact there are many unknowns in the area. Because of that, helping people identify the purpose of why we do what we do is one of the key areas in which we need to emphasize, that if you stick to the path of purpose, then your vulnerability stops being the biggest hurdle. For example, with the use of digital tools. They have entered our industry slowly but also showed that the ability of stakeholders to adapt to unforeseen situations is enormous. We have catapulted decades of digital technology adaptation in the last two years, something that would probably not have happened in the next decade. In short, there are two main lessons; understanding that you will be vulnerable despite the plans you may establish; and the need of mastering the agility to adapt and change. The key is to prepare your organization with that mindset.

EF: Can you describe your footprint in Singapore regarding clinical research, collaboration, and pipeline/portfolio? What are you excited about?

PC: Because of the complexity of running the trials, we had to rethink the area and we restarted two and a half years ago. Collaborations happen at different levels, with clinical trials developing in line with our global and local goals. For example, we currently have treatment trials for Nonalcoholic Steatohepatitis (NASH), cardiac-related complications, genomics, and liver diseases, among others. These are the areas that follow our spectrum from basic research to clinical research both in global and local operations.

EF: You seem to be very focused on educating the communities in taking obesity as a serious problem. What is your pipeline in this area?

PC: The health system, in general, is not prepared to attend obesity patients; chairs in waiting rooms are small size; so are examination tables; there is a lack of bigger cup sizes for blood pressure monitoring; a vast majority of clinics don’t have calibrated scales for more than 120 kilos; the most common answer a patient like this receives is that they need to lose weight. This is just a depiction, but it helps to understand why there are so many people reluctant to get treatment.

Obesity is a chronic disease with loads of factors involved, causes could range from genetic, to psychological to hormonal, which is why a general practitioner should be able to provide support mechanisms. The first item on our pipeline is to create awareness by working with other stakeholders and using different platforms to encourage people to take action. Once we achieve that, the challenge is where those people go to get treated, given there is no speciality that focuses on obesity. Therefore, training the medical staff is our second biggest crucial task, which is why we impulse initiatives such as OPEN (Obesity Policy Engagement Network), an annual platform in collaboration with foundations and the Singapore Association for the Study of Obesity (SASO), where we offer 8 hours certificated course on how to manage obesity patients. We then connect patients that seek to be treated, with doctors that have been trained.

This is how I see the future of obesity going: drive awareness, educate health professionals so that they can tackle the patient’s needs, connect those two factors through digital platforms and work with

stakeholders to connect patients with effective treatment. We are providing education that goes in line with reducing that gap so more people can benefit from it because selling drugs isn’t what saves patients.

EF: That is a great description of what it is to manage a therapeutic area both understanding the ecosystem and mental health advocacy absence. What do you expect the industry will need to advance from prevention to also treatment?

PC: The key is to plan sustainable solutions not short-time profits, that hinder the ability to establish as a partner and relegate you to being a service provider. There are two big guides for the pharma industry. First, not improving the patient’s outcome is not in your good interest in the long term which is why it’s imperative to make sure the company is delivering the best possible solution. That means always seeking better prospects for the patient, living longer and healthier, and not limiting the treatment to decreasing blood sugar levels. Second, is the importance of collaboration. The expertise is out there to help enhance the whole process, from awareness to treatment adherence. Therefore, it is crucial to get the people within your organization to understand this.

EF: Novo Nordisk is celebrating its 100th anniversary next year. What will your speech be like to your employees?

PC: It’s been 100 years and we are still supporting people suffering from these diseases, this tells us the philosophy and the spirit has been right. The company was established with a simple fact: insulin is a phenomenal treatment option and people need it to be accessible. The objective has always been to take advantage of the area where we have the expertise and provide the best solution for a vast majority of the people. Looking into the future, I would tell my team to keep doing our jobs not because we must, but because we have a clear patient-driven objective in mind. When we celebrate 200 years anniversary I won’t be there, but I’m sure this is the mindset and legacy we are leaving the next generation, and it’s what makes it fulfilling.

October 2022