February 19, 2013

The drama in drug development.

In 2005, playwright David Mamet* wrote a memo to the writers of the TV show The Unit that went viral on the internet. I have taken some liberties to adapt the memo to pharmacometricians on drug development teams. If you read the online version of the real memo, you will see that I did not have to do much editing, save for redefining the word “drama.”

To the pharmacometricians on the team:
Greetings.
    Everyone in creation is screaming at us to make the story about our drug clear. We are tasked with, it seems, cramming a whole boat-load of information into a little bit of time.
    Our friend, The Management, thinks that we, therefore, are employed to communicate information—and, so, at times, it seems to us.
    But note: The Development Team will not tune in to watch information. You wouldn’t, I wouldn’t. No one would or will. The Development Team will only tune in and stay tuned to watch drama.
    Question: what is drama? In literature, drama is the quest of the hero to overcome those things which prevent him from achieving a specific, acute goal. In drug development, drama comes from the quest of The Company to overcome those things that prevent it from achieving the goal of putting a new drug on the market.
    So: We, the pharmacometricians, must ask ourselves these three questions before every Development Team meeting. 1) Who wants what? 2) What happens if they don’t get it? 3) Why now? The answers to these questions are litmus paper. Apply them, and their answer will tell you if the meeting is dramatic or not.
    There is no magic fairy dust that will make a boring, useless, redundant, or merely informative PowerPoint presentation dramatic after it leaves your computer. You, the pharmacometrician, are in charge of making sure every presentation is dramatic. This means all the “little” expositional slides of parameter estimates or goodness-of-fit plots (and we all tend to include them on the first draft) are less than useless, should they finally, god forbid, get presented to The Management.
    If the presentation bores you when you practice it, rest assured it will bore the rest of the people in the meeting, and it will bore The Management, and then we’re all going to be back in the breadline.
    Every meeting must be dramatic. That means: The Development Team must have a simple, straightforward, pressing need that impels it to schedule the meeting. This need is why the team shows up at the meeting. This need is what the meeting is about. The attempt to get this need met must lead, at the end of the meeting, to resolution - this is how you know the meeting is over. It, this resolution, will, then, of necessity, propel the team into the next phase of development. All these needs and resolutions, taken together, will, over the course of the program, constitute the plot of the regulatory submission. Any meeting, thus, which does not both advance the regulatory plot, and stand alone (that is, dramatically, by itself, on its own merits) is either superfluous, or incorrectly executed.
    Yes but, yes but, yes but, you say: what about the necessity of presenting all that “information?” And I respond “figure it out.” The job of the pharmacometrician is to help The Development Team, and thus The Management, understand what happened and to have a clearer picture with which to wonder what will happen next.
    Any scientist can write, “We need to do another study.” You are not getting paid to realize that The Development Team needs this information, but to figure out how to present the material before you such that The Development Team (and subsequently The Management) will be interested in what happens next and will understand how and why the study needs to be done.
    Start, every time, with this inviolable rule: the meeting must be dramatic. It must start because The Development Team has a challenge, and it must culminate with The Development Team finding themselves either thwarted or educated that another way exists.
    Here are the danger signals. Any time the presenter is talking about standard errors, the presentation is a crock of baloney. Any time the presenter is saying “as you know,” the presentation is a crock of baloney. Do not write a crock of baloney.
    Remember you are writing for a visual medium. Most presentations sound like radio. The slides can do the explaining for you. Let them. What are the drugs doing -*literally*? What are they affecting, where are they going? If you pretend the slides won’t have narration, you will be writing great drama. If you deprive yourself of the crutch of narration and exposition, indeed, of speech, you will be forced to work in a new medium–telling the story in pictures. This is a new skill. No one does it naturally. You can train yourself to do it, but you need to start.
    I close with the one thought: look at the presentation and ask yourself “Is it dramatic? Is it essential? Does it advance the plot? Answer truthfully. If the answer is “no” write it again or throw it out.

    If you’ve got any questions, call me up.

Are you hooked? Check out the previous Pharma of the Future? blog entry, Insight. . .Inspiration. . .Innovation. Or visit the Pharma of the Future archive to catch up with the future of pharmacometrics.

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*Mamet is a Pulitzer Prize-winning playwright, screenwriter, and director who was the creator and executive producer of the TV show The Unit, which aired on CBS from 2006 to 2009. The Unit was “an action drama that followed a covert team of Special Forces operatives as they risked their lives on undercover missions around the globe, while their families maintained the home front, protecting their husbands’ secrets.”

To read more about the use of drama in corporate leadership, see Daniel Goleman’s recent LinkedIn blog entry: Effective Leaders Are Effective Storytellers. Goleman quotes Howard Gardner: “I’m absolutely certain that a very important part of any new invention, whether it’s mechanical or literary or artistic, is a narrative vehicle which helps people relate to that. It helps them understand the ways in which it is complementary to, or consistent with or directly in clash with, what you did before.”

 

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