Last month's “In Practice” column focused on Proposition 71, California's legislation earmarking specific funds for stem cell research that has helped draw neurologists and neuroscientists to the state.
A 2004 study from Ernst & Young LLP, confirmed that California is already a leader in biotechnology, having the largest number of biotechnology companies of any state, and a 2004 study by the Milken Institute and Deloitte & Touche found that California metro areas account for half of the 12 largest biotech centers in the US. Among those making the transition to industry are neurologists, many of whom have decided to give up clinical practice or academic medicine to pursue a career change.
A RAPIDLY MOVING FIELD
One such Californian, Stephen J. Peroutka, MD, PhD, was a neurologist on the faculty at Stanford before going to Genentech in 1990, later becoming a consultant for the biotech industry for several years and ultimately launching his own company Synergia Pharma, Inc., in 2002. The company focuses on the clinical development of novel therapeutics for the treatment of migraine.
“There are great advantages to working in the biotech field,” he said. “If you have an idea, you can get it funded and completed far, far faster than is possible in academia or even the pharmaceutical industry… consider the speed of a large aircraft carrier versus a speedboat,” he suggested. “However,” he added, “the disadvantage is that this is a rapidly moving field and you need to be extremely flexible, because management may decide to go in a different direction at any moment.”
He advised neurologists, “If you have lots of ideas or like to hear other peoples' ideas, it is a great life, rewarding both financially and creatively. But if you are someone who needs stability – as most neurologists do – it may be too nerve-wracking. That's the trade-off.”
AN ESTABLISHED RESEARCH FOCUS
“In biotech you are coming to a place where a company has an already established research focus, and you need to adapt to that area and give up the control that you may have in your own lab,” agrees Dawn McGuire, MD, Chief Medical Officer at Avigen, a publicly held biotech company in Alameda, CA.
Dr. McGuire trained in neurology at the University of California-San Francisco (UCSF), completed an NIH-funded program in experimental therapeutics, and served as full-time faculty in the UCSF Department of Neurology. She has led several programs resulting in FDA approvals for novel treatments for conditions such as multiple sclerosis (MS) and intractable neuropathic pain. She heads Avigen's human clinical research programs in gene therapy and other experimental therapeutics in neurological disease and is currently working on gene therapy for Parkinson disease.
“I wanted to do human clinical trials with new neurological therapeutics,” she said. “Biotech provided the option to do clinical investigations.”
Dr. McGuire advises those interested in biotech as a career: “It is easier to get grants and sponsorship than in academia, although even academic centers are recognizing that sponsored clinical trials can serve as a good source of revenue.” Dr. McGuire notes that the economic pressures on practicing physicians and academicians have increased greatly over the past decade. However, like many neurologists in industry who also enjoy practice, she still sees patients, running a clinic for AIDS patients with neurological problems.
A PLACE FOR CREATIVE RESEARCH
Craig H. Smith, MD, spent 25 years as an MS specialist before moving to become a Senior Medical Director in Specialty Biotherapeutics at Genentech last year. He currently runs its neuroscience program, which includes three MS clinical trials. “Biotechnology represented an opportunity for me to do creative research unfettered by the political and financial constraints of academics,” he said. “The mounting frustrations of clinical practice led me to consider that the remaining five to 10 useful years might be better spent doing creative research based upon my expertise rather than trying to correct problems for which I have no skills.”
Dr. Smith finds his new career more professionally fulfilling than he thought possible and said, “I am learning daily, developing new skill sets and integrating ones that I had into a larger picture – one within which I am able to help a larger number of patients.”
RISK OF FAILURE IS HIGH
Donald F. Weaver, MD, PhD, Canada Research Chair – Professor and Clinical Neurologist – at Dalhousie University, trained as a neurologist, completed his PhD in chemistry and has been involved in several biotech start-up companies over the past few years. “It is intellectually exciting to be in biotech,” he says. “If it succeeds, it can be quite lucrative, but the risk of failure is quite high.”
“Multinational pharmaceutical companies provide better long-term job security but expect you to work on what they tell you to work on. Biotech companies provide a greater degree of intellectual freedom but because they are generally smaller firms, you are expected to be a jack-of-all-trades. They also tend to give you greater ownership of intellectual property. If you come up with an invention, you will reap higher benefits than someone who works for a drug company and signs over ownership to the corporation. However, the likelihood of going bankrupt is higher.”
PHARMA FIELD, LESS RISKY
And many neurologists prefer working in the less risky pharmaceutical industry. Dennis W. Choi, MD, PhD, Executive Vice-President of Neurosciences at Merck Research Labs, is responsible for the discovery and early clinical development (through proof-of-concept) of drugs targeting diseases of the nervous system. He practiced clinical neurology and performed laboratory research as a member of the faculty at Stanford, and later was Chair of the Department of Neurology at Washington University, before joining Merck.
Dr. Choi said that he had always been interested in contributing to the development of new treatments. “In my research as an academic neurologist, I worked to understand mechanisms underlying brain or spinal cord injury,” he explained. “This was very satisfying, but I realized that if I wanted to participate more directly in moving something to the bedside, I would somehow have to join forces with industry.”
He added, “Merck has built up a significant basic and clinical neuroscience research enterprise, seeking treatments for a broad array of neurological and psychiatric diseases, including treatments for chemotherapy-induced nausea and vomiting; insomnia; and acute stroke. Overall, across all therapeutic areas, Merck commits more than $3 billion a year to fund its research labs.”
ON TO PHARMACOGENETICS
Allen D. Roses, MD, has been Senior VP for Genetics Research at GlaxoSmithKline (GSK) since 2000; from 1997 to 2000 he was Vice President and World Wide Director, Glaxo Wellcome; and prior to 1997, he had served as the Jefferson Pilot Professor of Neurobiology and Neurology and Director of the Center for Human Genetics at Duke University – as well as Chief of the Division of Neurology in the Department of Medicine there – where he led the team that identified apolipoprotein E as a major susceptibility gene in common late-onset Alzheimer disease.
While at GSK, he has been applying pharmacogenetics to develop and implement better-defined medicines for patients with specific disease susceptibilities in the GSK high-throughput human disease-specific target (HiTDIP) program – which provides genetic validation for target selection to drive the pipeline.
Most neurologists believe that their background and training has been quite useful. Dr. Choi stated that both the specific understanding of neurological diseases, and the more general training in problem-solving gained during his residency and later through his neurology practice have been invaluable assets to him in his current position. “My experience of working directly with patients with neurological diseases remains for me vivid, deeply moving, and a daily motivator to work harder at my job.”
WHY THEY LEFT
Dr. Choi also voiced relief at not having to deal with the administrative aspects of patient care. “I certainly do not miss stacks of forms associated with clinical practice!” Like others in these industries, he finds his work fulfilling. “The prospect of being part of a team that brings a needed new therapy to medicine is absolutely thrilling,” he said. “My sense is that the number of practicing neurologists considering or choosing careers in the biotech and pharma sectors has grown recently, but I do not have any numbers.”
Dr. Roses said he was drawn to the pharmaceutical field by its ability to apply genetics to pharmaceutical discovery and development and has found the transition fulfilling. After spending 27 years in academic neurology and genetics, he said, “Part of my decision to leave was due to experiencing the frustrations of university politics, and flawed peer review.”
Dr. Smith said, “Many of my peers are now calling me and asking for positions with me at Genentech. That is a telling statement.”
ARTICLE IN BRIEF
- ✓ Neurologists who left academia for careers in the biotech and pharmaceutical industries discuss the challenges and opportunities.