Dr Sonit Handa — From Physician in India to Building a $1M-a-Day Children's Cancer Tissue Bank

Adam Walker:I'm Adam Walker, a biometrics consultant and this is the Pharma Prescribed podcast, where: leaders, innovators and hidden voices in healthcare open up. No sound bites, no spin. Just raw insight, one prescription at a time. In an industry driven by: data, protocols and pressure; we rarely pause to ask the human questions:

What drives us? What breaks us? And what truths live behind the titles we wear?

Adam Walker:Dr. Sonit Handa is the founder and CEO of Biovance Consulting, where he helps organisations navigate global launches, operating model transformations and post-merger integrations. He trained as a physician in India, then moved to the United States to study Biomedical Engineering, drawn to the intersection of: medicine, science, technology and business.

Over more than two decades, he's held several key leadership roles, working across: clinical development, reg affairs, market access, commercial operations and transformation. Through Biovance, Sonit helps biopharma leaders align strategy and execution across their organisations.

Sonit, for those of our audience who are not familiar with you, who are you and what is the mission you're on?

Sonit Handa:First of all, Adam, it's such a pleasure to be talking to you in this chat. Thank you for inviting me. Really appreciate it. Now, to address your question: the mission I'm on is to help life science companies bring breakthrough innovation to patients where we can change their lives for the better.

Adam Walker:How do you go about doing that?

Bringing breakthroughs to patients' lives?

Sonit Handa:So the way I have been able to do it is throughout my background by leveraging experiences and training in: medicine, science and business. I have been working with pharma biotech leaders to think through the complexity of actual execution of the strategy they come up with and then working with their teams, orchestrating all the Subject Matter Experts and the functional teams behind a common vision to execute all those plans and make those visions a reality. I have been doing that as a consultant, as well as having been in the industry in a variety of multinational companies, in a variety of functions.

Adam Walker:Thank you very much for explaining that.

Adam Walker:You've got a very interesting background, Sonit, in the fact that you trained and qualified in India as a medic and a physician and you then decided to transfer your life into the US.

That must have been a very big decision and one that I'm sure is not easily smoothed over, but perhaps for our audience you can elaborate a little bit further on how that came about?

Sonit Handa:Yeah, that's a great question.

It was not by my dreams and design when I started medicine. When I was back in India traditional routes of career are either you become an engineer or a doctor.

I was always interested in Biology and so medicine was the obvious answer and I was able to score my marks, get into medical school and I was able to get good grades there. But I saw that everyone around me at that time was running the same race, as we call the 'Rat Race' in corporate, it was basically the same thing here. Everyone wanted to become either an OBGYN (Obstetrics & Gynaecology) or internal medicine and I was just wondering: if everybody is doing this, then what about something else? There has to be something else beyond traditional medicine...

Sonit Handa:At that time, in around 1998, '97, medical transcription from US was being outsourced to India. Now, I had not heard of medical transcription. It was something which trainers for a medical transcription company. I showed up and I then saw the first time how technology was being used in medicine. That was the first indication of outsourcing from US to India and I was intrigued because they still wanted all the capabilities and my training of medicine, but was being applied to a technological way of business.

That was interesting, and I said: "Let me take that" and through that experience, I saw how technology can transform healthcare, because even though it was not directly impacting the patient, it was indirectly impacting the patients. When I started researching into that and that time was when the cyber cafes were becoming more popular in India.

I started researching and some of my friends, they actually came to US to do Biomedical Engineering. I got intrigued with that, I started researching, what is Biomedical Engineering? Cell and Tissue Engineering caught my attention, because Cell and Tissue Engineering was offering things like: artificial organs, artificial pancreas. That was when I saw that there's a new dimension of medicine. It is not just the traditional paths, but it is how can you take technology and move it to the next level? So by nature, I was somebody who wanted to explore new possibilities by creating new dimensions and that's when I said: "Let me try for Biomedical Engineering." That's what brought me to the US and it was a tough decision. I was an only child and my parents were alone in India. But, as a first-time immigrant or first immigrant anywhere in the country, whether it's in US or UK, that's a tough challenge, but somebody's got to do it. My parents were very supportive of me coming over here and exploring the new career that I could potentially get.

So that's what brought me to Biomedical Engineering at the University of Memphis.

Sonit Handa:I did my Cell and Tissue Engineering there and after that I got an offer to join St. Jude Children's Research Hospital, which was in Memphis.

Now, St. Jude Children's Research Hospital, it's very famous for being a Non-profit Cancer Research and Treatment Centre. No patient has to pay for any treatment there and it is funded entirely by donations. I still remember- I joined it in 2003 and at that time, the CSO or the CFO had mentioned that it takes approximately $1 million a day to run the operations and to provide support to family members who come and visit and stay with the patients. That's when I was excited about working in such an organisation. What they wanted me to do was actually to set up the operations of their tissue bank. So they had been storing tissue samples for 25 years prior to me joining, but they didn't have proper inventory. They didn't have proper database and they wanted somebody who can set up the operations, can run the inventory of all the samples in the liquid nitrogen freezers or the minus 70 freezers so that it would become easier for people to request samples and to get those samples so that we could have more research published and discovered to help patients who are basically children.

So that's what brought me from medicine to the US for research.

Adam Walker:Wow. As you were talking there, I was thinking about a number of different things.

Firstly, it was, the accessibility of the US healthcare system and the fact that very unusually you've got a hospital there that you described where everything is fully funded. That's firstly standout difference.

Then secondly, it was the fact that they needed someone to inventorise an entire tissue bank. It reminds me of some experiences I've had in my past as well, where I had to do similar things where everything was on paper and had to be translated into an electronic. It was probably around a similar sort of time- early 2000s, where things were starting to be digitised, wasn't it?

Sonit Handa:Yes, exactly. There was no database system, so I was working with the IS team to develop an electronic database. At that time, I still remember that was the first time I heard the term GUI and I was wondering, what is GUI? That's when I heard it was Graphic User Interface. So I still remember that, which was simple boxes, et cetera, which now of course is a totally like ancient history. But that was a time when I'm applying: medicine, research, technology and operations to make something which is going to benefit patients.

Adam Walker:Yeah.

It's an extraordinary point you make.

Adam Walker:We find certainly in many of the conversations I have on this podcast, there are many people who come into the particular positions that they find themselves and through either serendipity- right place, right time, right people. I'm assuming that there were people that you were working alongside at that time that saw something in you and gave you an opportunity that perhaps someone else may have just looked over.

Sonit Handa:That's absolutely true. But we were having this discussion earlier. Some of these things are also due to the constraints of the immigration system. So at that time, when I had just graduated this was about in 2003, there were visa restrictions. So we had to be getting a job quickly after the OPT, et cetera. There were so many applications I sent out, reaching out, cold emails, et cetera. I still remember remaining up all night. My wife was helping me. I was working on this, et cetera. Of all the people I wrote to across the US, the response I got was from the CSO of Memphis- where I was living.

It was absolutely correct, as you said. It's all about the right place, right time, right person. I was there. I met the lady her name is Sheila Shurtleff and she offered me this position and it worked out, because it's not only the skills, because it's also the cultural fit. In St. Jude Children's Research Hospital, the mission, all the people who are working for a non-profit organisation, you have to be driven, but you have to be kind to each other. Because we have to understand what is the overall mission of the organisation and thereby the culture of the place.

Adam Walker:Yeah. You just reminded me of a recent episode I recorded with a guy called Graham Alcott and he's written a book about kindness in the workplace and he speaks to the point that: many people can work in different organisations, but if they don't have the right attitude and the right capabilities and culture to fit, but also to work alongside other people and integrate into that, they're not gonna last very long and that's certainly been my experience and by the sounds of it, it sounds very similar to your experience as well around that piece of kindness.

Sonit Handa:Absolutely.

That particular cultural fit has continued throughout my journey till now- is to try to make sure that the organisation or the team within an organisation that I join is the right cultural fit. We talk about this in corporate, whenever there's those job descriptions, they talk about your culture, et cetera. But really, nobody defines what a culture is.

Culture, I feel, is a emotion, is what you feel. It's not something you can describe. You can use words, but it's only when you start feeling, as they say, if on Sunday evening you are getting, you're dreading Monday morning, then you know you're not the right fit.

Adam Walker:Yeah.

It's been a while since I've had that experience. Thankfully as an Independent Consultant, the drive to get yourself out of bed in the morning is a lot different, isn't it? I gather that over the years, not only have you worked in many corporate organisations, but you now work and run your own company.

Can you tell me about how that all came about and how you came to be in this position now?

Sonit Handa:Yes, of course.

Sonit Handa:So after doing the stint in St. Jude Children's Research Hospital, I was at a decision-making point that should I, like all of my other friends who came from my medical college in India, or traditionally, should I take the USMLE (United States Medical Licensing Examination) and get into clinical medicine, or should I take an alternative path? I knew that I did not want to continue in the traditional medicine route, because again, I would get into the same race, which was getting into residency, et cetera.

That was one way I could have gone.

The second one was research. I did realise my personality is something that I want to move faster. Research is a little slower for me, the slow pace. Then reflecting back, I realised the one thing that I really enjoyed, whether it was at an in rural hospital in India, where I was doing my post-internship, my work, or it was at the medical transcription company or at St. Jude. What I really enjoyed was the process, which is:

Why are we doing this?

What are we going to be doing?

How are we going to do this?

Who's going to do it?

When are they going to do it and what will be the outcome that we can track?

I realised that this was leading up to processes, operations- number one.

Number two, in all this process of working in a or working at St. Jude, I realised that I could make an impact on a patient one-on-one if I was a physician. But how would I be able to scale that impact? That's when I realised getting into an organisational role, which is creating medicines and delivering medicines across the globe- that is going to scale my impact from being a single physician to being able to one patient- to multiple patients.

So when I tied all these things together and the fact that I didn't want to go into the traditional route, but create a new dimension, that's when I decided to do my MBA and Duke University, which has got the Fuqua School of Business and it is the one of the only programs which offers a separate curriculum and degree on Health Sector Management, apart from the general MBA.

I went there, I visited that and the cultural fit, because at that time I was married and we were expecting our first child. So the feel of the entire university, the Fuqua School of Business, the students who were there from the former students alumni, as well as the fact that it was focused on HSM or the Health Sector Management. That's what drove me to decide that I wanted to go to Duke University, because I would then be having the same theme, because healthcare and Biology is common. I love Biology and healthcare. I'm not stepping out of that zone. The industry remains the same, but different perspectives are added from: being a medical doctor, also being a caregiver, to being a scientist, to being a business operator or business leader in healthcare.

So that's what drove through and I did my MBA at Duke University.

Following that, I joined Deloitte Consulting and then other companies like: Amgen and Horizon Therapeutics and Astellas in different roles.

Sonit Handa:But during these times, I realised and I was fortuitous to get into positions where I could drive enterprise-wide strategic initiatives. For example: launch excellence- which is launching a product in the US or ex-US, or it was mergers integrations or transformations, which is changing the entire way of ways of working for a commercial organisation.

So through all these experiences, I realised that's what we need and that's what my identity was. You can consider me as the orchestrator or the integrator who is mile wide, inch deep, working with all the SMEs or Subject Matter Experts who are inch wide, mile deep. Because what we need is all these Subject Matter Experts to be connected, their plans to be connected, the interdependencies to be connected, assumptions to be shared.

That is a rare talent. Because I have: the background in medicine, my interest in medicine, research and business; I am able to provide that connective tissue which will take the whole organisation forward. So that's what drove me and all my decisions till now. Then finally, when I was able to get this opportunity, on a personal note, my son Shaurya, was joining Indiana University of Bloomington for Kelley School of Business and we had a option of starting on my own. That's when my wife and I decided that let's go and do this. So that's how I started Biovance Consulting.

Now again, I'm able to scale my impact because earlier I was restricted to scaling my impact only with one organisation. But today, I am speaking to you. Last week or two weeks back, I was in a summit where I had other leaders of organisations there.

So now I'm able to scale my impact using my experiences and expertise in life sciences and biotech.

Adam Walker:Thank you, Sonit. That's a wonderful explanation.

Adam Walker:Again, there's so many thoughts that came to mind as you were talking around that, not least: how on earth do you get off the treadmill and jump on a MBA at Duke University when you've got, a life to continue and commitments outside of that?

I'm assuming that was fully funded, but perhaps you can just tell me a little bit more about that? But on the back of it also, we have a lot of listeners students who are coming into this industry for the first time. What you've described is lifelong learning. You've done: a medical degree, Medical Engineering and then an MBA.

That's three significant chunks of time in your working life, never mind your professional life, where you've: taken a step out, re-qualified, continued to train. How did that all fit around the finances and the day-to-day and how did you reconcile that with what you had to achieve?

Sonit Handa:So it cannot be done without good support and for me, in the earlier part when I decided to come from India to US, it was my parents who were supporting. I know it was very tough decision for my mum because I was her only child and to let somebody go from your life, because I feel that now, we have only one son. But then when I decided to go for MBA, it was my wife, Kaveri, who had a major supporting role. Because it was: her support, her confidence in me and her agreeing that: "Okay, let's do it, because that's what's going to make your career and your dreams fulfilled." So that is very important. So now for students who may not be married, typically if you're early in the stage, or if you have a significant other, you have to consider that person's feelings and you need to have that support, without a doubt. Because the other thing is Adam, that my MBA was not fully funded. I took a loan for me, my wife and in the second year for my son too. You have to understand, my wife played a major role in supporting me in that. But then after we got that and then luckily, due to my MBA, my job that I got, et cetera, we were able to pay off slowly over time and we have done that. Now we are living where we are. We have a permanent residency, et cetera. So I would say that was definitely needed. Now, beyond that, it's your own drive. What motivates you? So you have to understand that for me, when I reflect back, even though I had not planned that, but it was about adding new dimensions. Because when you go to a medical school, earlier I was a topper in my school and my area or whatever you can say, then you are now surrounded by all the toppers. They're all wanting the same thing, but there's limited seats.

So the question that I would like to pose for the students is that you don't have to compete in the same race that everybody else has decided that this is the race. You can create a new dimension and that's what I have done. I was able to take my medical degree and go to Biomedical Engineering, and then from Biomedical Engineering go to HSM. From there I have done consulting and nowadays it's all about AI, which is gonna offer so many multiple dimensions. So the point is: do not let your imagination be the one which is limiting you. You can explore endless possibilities and then you can create your new dimensions and you can create that particular niche for you. You will have to discover. The point is- explore possibilities. Keep trying things. Do it for two years. Do it for three years. Some people say you have to keep doing it for five years, ten years, then you'll achieve success. But there's also another way. Maybe you do something for two years, then you switch to another thing in three years. As you are growing, you can be doing this and you will see there's a theme that'll come out, or there's one or two things that will really stick with you and now you will know that you have a niche, which is the combination.

I was working in a company called Astellas, which is a Japanese company, in 2016. I was interested in learning Japanese language, which I did not. But one of the things, the terms come there and one of the terms was Ikigai. So Ikigai, which now is very popular and famous, is basically- consider three circles of a Venn diagram:

What is it that you like to do?

What is it that you're good at and what is it that the world will pay for?

You find that common thing in the middle, that's what your Ikigai is. I was lucky to discover the Ikigai over the process. So maybe you will not know your Ikigai right when you start, but be open to that you can explore many possibilities.

Adam Walker:My grin is getting broader and broader as you were talking about that, Sonit, because of course I am also familiar with the term Ikigai and this podcast was born out of that idea. The idea of, what is the gap that you're trying to fulfill? For me, definitely it was putting myself in front of interesting and interested people, but also the service to others being, the next generation of life scientists coming into this industry and just opening up wonderful and interesting and fascinating conversations with people like yourself who are just leading with honesty and truth and breaking down many of those preconceived ideas around what careers look like today, how we can potentially push open those doors as hard as we possibly can? But I think, it's just a really rich insight that you give there into the fact that we're always: trying, pushing, learning, doing new things. I think we're of a similar generation and those who don't continue to learn or change and develop, they fall by the wayside! If we've learned anything about this current- yeah- generational change with AI, it's really that, isn't it? It's change or be left behind!

Sonit Handa:You're absolutely right.

Sonit Handa:Most importantly, because of AI, which everybody's saying right now, we don't know what line of education should we send our kids in because everything will change in a matter of few years, right? Which is, again, the reason I'm highlighting the fact - create your new dimensions, explore the possibilities; because whatever we know right now will not likely exist in the next few years. So what those kids do right now? I have my son, he's now going to be in second year of undergrad. I have these same discussions with my friends. What is it that we should be teaching them? One thing is, that is going to continue, is as long as humankind, human race remains, we will have to interact with each other, preferably directly rather than having our avatars talking to each other. So: interpersonal skills, cultural fit, having EQ as much as important as IQ. Those are the things that we should be encouraging our kids to do. Now, there are traditional roles, like medicine is still going to be needed for some years or more. We will need that. There could be some other roles that would be needed, for example, a dentist. I'm right now not sure that I want an AI robot to touch my teeth, that takes time. But there will be some traditional roles, but even those will be impacted by AI and not everybody wants to become a doctor or a dentist, so for all the other generations, that's what my message is: explore new possibilities, create your own new dimensions...

Adam Walker:Yeah, I think touching on that point around EQ- Emotional Intelligence really what I've learned through doing the podcast and speaking to people like yourself has really been the power and the value of connecting. Now, the fact of the matter is that we're thousands of miles apart right now, but on this particular screen it's just you and I having this conversation. As far as I'm concerned, we are connecting on a very deep, personal and visceral level and it feels like we're in the same room. Now, there is no time delay and in the past we wouldn't have even been able to afford a phone call. But this is effectively the value of doing what we're doing on broadband, isn't it? On fiber optic broadband cables. It's extraordinary how small the world has become and how incredibly orchestrated certain things have now become for us.

My point, I think, that I'm trying to make around that is: "Yes" to all of the things that you said, I completely agree with you. I think there are further skills that we can learn. Of course, we're gonna need: plumbers, electricians and the very basic things that will require human hands and eyes. But only earlier today I was recording a podcast with someone who had keyhole surgery by a robot!

Sonit Handa:Yep.

Adam Walker:You were talking about you wouldn't want a robot in your mouth. This guy had his prostate removed by a robot and it was perfect. He had no damage to the nerve endings; he came out and had full function as a result of that extraordinary surgery that he experienced.

So the world is moving at an extraordinary pace, isn't it?

As parents and leaders and innovators, I think, like I said, we need to embrace those opportunities to really connect with human beings and it's something that I also say to my own kids, who are of a similar age, is just that: " Take the time, turn off your phone, engage with the people that you're talking to, give them your entire attention." I think the attention deficit that we're experiencing as well, where many people cannot keep attention for any longer than a matter of seconds, is in and of itself a differentiator. Would you concur?

Sonit Handa:Absolutely, I agree. Even now, when we look at when we are having TV, I have my laptop with me, plus I have my iPhone with me and my attention is diverted across all three. Now, this is not optimum, no doubt about it, but we have gotten to that stage. The younger generation, which is actually growing in their strollers, with the iPads. Mothers typically give the kids in the strollers an iPad to keep their attention there. Imagine how diverted their attentions will be, or their attention span will be shorter and that's actually having anatomical impacts on their eyes! So the entire thing is going to change. In all this, that's why the old sciences of yoga or meditation; if we just take meditation- that's making a comeback because people are realising that there was a merit in all those things that could help in the emotional wellbeing of individuals. That tied with physical exercise, et cetera, is going to be what is important and I'm realising that too.

Adam Walker:As a physician and a medic, presumably you've seen an awful lot of development of physicality or lack of physicality over the years, particularly, where you are now in the States. I'd love you just to give your perspective on that as a physician?

Sonit Handa:It is nothing new that everybody has realised, because of technology we are able to get escalators and elevators and those kind of things, which prevent us from walking stairs. Now, that's a good thing in many cases, but it is also having its downside.

So it's finding the balance. That's why nowadays they say: "Hey, instead of taking an elevator to walk two flights, why don't you take the stairs?" So you have to find the balance. I'm not saying that you don't need the technology to help you, cars, et cetera. You don't need that, but you've got to find time to get off the seat, walk after sitting for 45 minutes, make a deliberate impact, a deliberate note to walk for 15 minutes or something like that. So you've got to do these things, but as a result, there's illnesses and diseases, the chronic diseases like obesity, diabetes, which are on the rise. Thankfully, there's again, the medical innovation, GLP-1 drugs, which are coming to the market and there's more and more innovations happening. From an injectable GLP, now we have an oral GLP-1.

So there's all these things happening, but in the end, you realise that if you could have done this without taking medication, it would have been much better.

Adam Walker:I agree.

Adam Walker:I think just following on from that point- the combination of your background in: medicine, science and business, that presumably it must have shaped the way that you now approach problems because your core skill has been developed around that Venn diagram of those three particular core skill sets, has it not? So when you go into organisations now, how many different lenses are you seeing things through?

Sonit Handa:So first of all, it begins with trying to understand the organisation- what are they trying to achieve? What is their mission? It's very important. Then it is to understand why are they facing this problem. First of all, is that the problem that we should be even talking about? Because sometimes clients who are so hyper-focused on their part of the world, they do not see that maybe the problem is broader or somewhere else. So helping them understand the bigger picture, and that's where I bring my experience of having worked across the value chain. So there is where I help them identify what is the right problem to address? After that is finding the solution. For example, another person reached out to me to help them come up with a framework for integrated evidence generation, because that person was in market access. But they said: "Okay, we just want to help our other functions understand that they should bring market access early on into the discussion." But I said that: "Okay, I can give you the framework," But giving the framework versus making it an actual part of your ways of working requires more than just giving you the framework. It first of all requires senior leadership buy-in, because the senior leadership should agree that is the way of working, number one.

Number two is to develop the framework with your stakeholders who are going to live the new life, the new way of working. Because then they will be sure that, okay, they have had their say in this particular framework and how it would work. It would be their skin in the game, too. Then we do the rollout and we do a trial run.

So just a problem that:"Hey, give me a framework to share with my other functions for integrated evidence generation," resulted into a more broader and more meaningful impact to the whole organisation.

So that's the kind of lens that I use to understand what is the overall program, what is the mission and then also working with different people, understanding to make a process happen, it's the people.

Adam Walker:Yeah, absolutely.

As you were describing that, I was thinking about how there is an uptake within organisations of change and we come back to this point of Change Management. It's something that I've seen and heard a lot of recently. I've been doing various innovation integrations in companies over the last few years myself. There is a whole new stream of Change Management and this capability that I never remember being there certainly ten years ago, but now it's a whole avenue all of its own.

Adam Walker:What's your experience of Change Management and how does that fit around these particular components that you described?

Sonit Handa:Change Management, you're absolutely right. A few years, not few years ten years back, it was not something that was highly popular. It was that, okay, we will come up with a new process. We'll roll it out. Everybody will be okay. But companies have realised that Change Management includes changing the way of working, as well as the people's mindset who are going to work, because nobody likes change. Let's be honest. Nobody, or literally many people, don't like change. They like to continue with what they are doing. But Change Management is all about convincing those individuals that the present way of working, if we continue, is not the optimum way. What would be the downside if we continue the way we are doing?

Then show them the benefits of changing to the new way of working and then take them through step-by-step how their work would change and take them through the training of the new way of working. That is what Change Management is about. Believe me, Adam, Change Management is in everything. It's day to day, it's Change Management.

Our world is changing. How can we not have Change Management being managed effectively in organisations? Now, in some organisations, there's a small team, typically in the HR, which is saying it's Change Management. But when I worked with some of those teams we had the entire reorganisation being done of a commercial organisation in a company. That Change Management team is not going to have enough bandwidth to be helping with the whole organisation of thousand plus people changing. So Change Management has to be done by the leaders. They have to scale it. They'll have to actually, basically bring it down to their individual teams and help with that by demonstrating change in their behaviour.

So Change Management, which now is actually gonna be more important with AI coming and changing everything that we're doing, how we are going to work? People are scared right now. They don't know whether they're gonna have jobs, et cetera, which everybody's asking. But all it means is we are going to have to change...

So people should start getting into that mentality that change is going to happen. Now, it's their choice how soon they get on with it.

Adam Walker:Yeah, I think those are all extremely valid points. Yet why is it that the biggest organisations seem to struggle the most with change? Is it because it's like trying to push a rock up a hill? Is it the reluctance to change? Is it the fact that they're highly bureaucratic, most of these larger organisations? How do you break it down into smaller steps to make a success of those changes?

Sonit Handa:I would say it all begins with the leadership. The leadership should show, first of all and that's what I have done, when we initiated, when we came up with the new ways of working, that we had a forum where the leadership came on the stage and they were repeating why we need to change. It starts from that, number one.

Then it has to be the behaviour that they demonstrate. How are they showing that they are open to change in their discussions with either each other or with their teams to guide them? Okay, this is what you have to change. What do you think?

Then comes the actual people on the ground. We have leaders, like directors and VPs. How do they show the change? Throughout this process, most important is they have to understand, as I mentioned earlier, not everybody's open to change. So they have to be open to having discussions of concerns that each of the individual contributors have. Why are they concerned about the change?

When you start having this discussion, can you actually get to the root of the reason why people don't want to change? When you get to that and you address that, is when you'll be able to get the person along the journey. So I think Change Management goes back to my earlier point: interact with each other, having EQ. That's what is most important going forward.

Adam Walker:Yeah, I agree. Just as you were talking about that, I was thinking that maybe Change Management is the thing that we should be telling our next generation of life scientists that they should be qualifying in, because, in fact, change, like you said, is everywhere. It's happening all the time. We turn on the television, it's change: politically, economically, geopolitically. That was just ringing in my head, so I had to get it out because I was thinking: yes, this is the thing. This is the thing. That's really helpful and really instructive.

Of all the areas that you've worked in across your career, Sonit, I know you've worked in rare disease and it's an area that I've found particularly fascinating myself. I wonder what rare disease has taught you and how that really aligns with some of the changes that we're seeing today, both in medical engineering and in the larger picture?

Sonit Handa:That's a great question.

Now, when I started back in med school, I had not heard of rare diseases. I had not thought about getting into rare diseases throughout my career. I stumbled on it because- I had that expertise of reorganisation or launching, et cetera and that's when I got the opportunity to join Horizon Therapeutics in Chicago, where I was leading the ex-US expansion program. Through that experience, I realised how rare diseases are very important because not many people are paying attention to the rare disease patients.

First of all, rare disease- if you just think about the definition and the way it works, there are so many rare disease conditions which have not got a name yet. Some of them may have got a denomination or a name called syndrome, because it's a cluster of symptoms and we don't know what to call it, so we call it XXX syndrome.

Then those who have a syndrome, some of them may actually have a diagnostic test. It could be some antibodies in the bloodstream or something like that. So then we are able to get an ICH code, I'm speaking from the US perspective. There's ICD code and those kind of things and a diagnostic test and then comes traditional treatment is steroids, or then you can have these drugs being developed by companies.

So the patients that we are gonna be serving through that route is very limited and we already know that to develop a drug in pharma biotech takes ten to 15 years. It takes millions and millions of dollars and then we can get a drug to maybe few patients. Right now we are all talking about N of 1 therapy also.

So when I went through this experience and I was learning more about rare diseases, I realised that rare disease patients are actually very underserved. Imagine this being in the US, so now think about the people sitting in let's say in India, in under-poverished countries, other countries. What are they impacted?

It takes such a lot of expense to develop this drug, so companies expect reimbursement, which in other countries, if it's not approved, people cannot get those drugs. Then those people who have it in countries which is not approved, they pay out of their pockets, but then other countries where the poverty is there and those patients may be a rare disease patient but have not even been diagnosed or don't even know that they have this illness, they cannot get it.

So I realised that this is such an important need to highlight in the world rare diseases, the reason why we need to have research, et cetera. So during this experience, I realised that was an important thing.

Number two is- that how much of a high touch we need to have with patients and their caregivers? For so many years, they have not got a name for their diagnosis. Can you imagine that, not knowing what I have? Which is going to be so critical or so mentally exhausting for the patient as well as the family because: the mother, the father, or wife or spouse, whoever it is, they are struggling because they cannot do anything and everybody wants to help. So that's when I realised that this is important.

Now comes the market access part, which is market access as in getting the drug to the patient, but also getting it reimbursed. This is where the major challenges are right now. How do we convince the payers to reimburse that particular product? With the current geopolitical changes of the pricing across the world, Europe making changes, US making changes, et cetera, it's even more difficult and right now not sure whether patients can get these drugs.

So this is a real issue going on and I am deeply committed to support rare disease companies get their products in the US or ex-US.

Adam Walker:Yeah, I think I'd echo that experience as well. As I said, having worked in rare disease myself, it's the sheer dynamics of the N of 1, or N of a very small pocket of people in some disparate parts of the globe usually, aren't they?

It can be very difficult for those people and I do recall on an occasion during our town hall meetings, the CEO, or the head of function would read out a letter from a particular member of the family who might have said: "thank you" for either sourcing the drug or getting it through a particular regulatory avenue, let's say- yeah- it was in Europe, US. You know what I'm talking about now. Yep. So it's really just making sure that if there is a drug that is available that could potentially be reimbursed, but certainly could save someone's life, that it goes there with a sense of urgency. Unfortunately, healthcare is not set up to work that way, is it?

Sonit Handa:No, it is not.

Sonit Handa:This is where I actually had some questions of ethics. So when I was a physician, my intention was help the patient, right? Then when I got into pharma biotech, I would see that in the US or in Europe, we are charging high prices and I would wonder how a patient in India, because I'm come from India and I've practiced there, I would wonder: how would they be able to afford this?

Then I learned, this is where my business experience came into play, that's why I wanted to do business, is that we have to have different rates for different countries. But still, those rates are very high. Yes, I would love for all medicines to be free for all patients, but that's not the reality. That's not going to be possible. So it's always a ethical dilemma that, okay, while you're working, how do you make sure that the medicines do get to the right patients? Then at the same time you got to understand that people who are working in pharma biotech, they also have families who may not be interested in pharma biotech, who may not be interested in medicine. They may be interested in other things, but they have to have a life, so we have to provide for them too. So you have a family. We have to take care of them too. So it was sometimes a question, it's a philosophical questions. It's not practical right now, but maybe one day it is.

Adam Walker:Yeah, I think it's just a, like I said, a rich insight that you give and bring to the conversation and it really does dovetail really nicely into, the overarching experiences that you've had.

At this point in the conversation, I wonder, is there anything that we haven't touched upon that perhaps we should have done, Sonit?

Sonit Handa:I would say the one part that we haven't touched upon yet is, where do I go from here? Because, as I mentioned, I'm adding new dimensions to my life and right now AI is going to be adding new dimensions and Biovance Consulting is my current venture and I don't know where I'm going to take it from here. For now, I know I'm reaching out and supporting multiple companies, life science companies, midsize to small size. With AI, I'm exploring new possibilities that, okay, how can I help in different ways? So I want, again, this lesson to be that: after so many years of experience, I haven't stopped the fact that this is a journey and it is going to continue to evolve like everybody else.

So keep learning is my message to all the students that I know that you want to reach out to.

Adam Walker:That's wonderful. Thank you, Sonit.

At this point in the conversation, I always like to conclude with a quick-fire round.

Sonit Handa:Yeah.

Adam Walker:I'm wondering, Sonit, what is the one piece of advice you would give to your younger self?

Sonit Handa:Yeah. I know. So I would basically go back and tell him:

"Don't worry, things will work out. You will not know what exactly is going to happen, but when you reach the other side, you will see that these things, all the dots connected and it made sense what happened with you happened. But at that time, too, be open to possibilities. Do not think that what has happened or what is there right now in your life is the only thing that'll happen."

Adam Walker:Great point.

What are the top three qualities you value most when building a team?

Sonit Handa:The first and most important is trust. I want to be able to trust the other individual, as well as the other individual should be able to trust me.

That leads to transparency. We need to be transparent with our feelings, with our thoughts, et cetera.

Finally, it should be about each individual knowing the strengths and weaknesses that they have or areas of development and knowing that as a team we will be complementing each other. I don't mean C-O-M-P-L-I, I mean C-O-M-P-L-E to each other's strengths and weaknesses, so that together we are able to achieve what we need to achieve as a team.

Adam Walker:What is your favorite thing outside of work?

Sonit Handa:I love to work out and this has been something which has been going on since many years. But now I have realised over time that health is truly the real wealth, Adam. I didn't realise that when I was growing up. At that time it was: "Yeah, sure, I'm younger. I can do this." But now when I'm at a certain age, I realised what my dad used to say is: "Health is the true wealth." So working out is very important and I'm glad that my son too and my wife too are working out. That is what is important. So for me, I enjoy that. But apart from that, sometimes: going for movies with my son, with my wife, having a drink.

Enjoying those parts of life because we are here not only to work, we are here to have a life, the one life we'll have. You could choose to be enjoying with your family all the time, but that's not practical unless somebody has given you ancestral wealth.

Adam Walker:Sadly not.

Finally, what is your number one golden rule in life and in business?

Sonit Handa:My golden rule is, as I mentioned earlier, keep learning, be open to possibilities. Even a simple, small idea could actually turn into a huge accomplishment.

Adam Walker:Thank you, Sonit. Thank you for your honesty. Thank you for your openness.

The way you described your life, both academically and professionally and I think personally, has been extremely open and warm. I think anyone listening or following this podcast will have a greater understanding of the person that sat in front of me today. All the way from, your original experiences back home in India to where you find yourself today in the US. We touched upon Ikigai, that resonates for me. Doing what you like, doing what you're good for and hopefully being paid for it. That's what we're all here for.

I think also just retaining that perspective around rare disease, why people do the work that they do, why you are doing the work that you do and why so many people that come on this podcast are so principled and live their values in everything that they do every day.

So I really just wanted to thank you for taking the time and being so generous with that time today, Sonit and being a wonderful guest on Pharma Prescribed.

Thank you.

Sonit Handa:Thank you, Adam, but kudos to you, too, for making this podcast happen, as well as identifying the people you would like to invite on the podcast and most importantly, making them feel comfortable in sharing their inner stories, as well as challenges with you so that we could share it with the entire public.

Thank you.

Adam Walker:That's very kind of you. Thank you so much for your time, Sonit.