Chief Medical Officer, AstraZeneca

Sure. I've lived long enough that the story has gotten longer. I was one of those people who, fortunately, have always been interested in everything and did well in school. I can remember starting at age ten or so — I'd spend the summer with my grandparents, and my grandfather would ask, "What do you want to do with your life?" I'd always have three or four things on the list, of course, and it changed every single year. But his second question was always, "And what are you going to do to get there?" That was a really important lesson to start with. Even though I had no clue at ten, it got me thinking along those lines.

I deliberately chose a university where I didn't have to declare a major to start with, one that had a very broad liberal arts education, because I couldn't make up my mind. When I finally had to choose a major after two years, I picked biology — partly because I did well in it, but also because it seemed to have the broadest number of career options. Then I chose pre-med, because there are so many different ways to be a doctor. As you and I were discussing: you can be a clinician, an academic, a teacher, you can work in public health, in business development, in politics or policy. And when I got through medical school, I picked internal medicine because it covers as many organs of the body as possible, and then endocrinology because those hormones touch every organ in the body. You start to get the picture.

One thing that changed for me: I come from a family of six kids, so I was very conscious of what medical school was going to cost. So I chose to do what in the US they call the National Health Service Corps scholarship, because I thought I was going to be a primary care doctor in an inner-city area and contribute to health policy. By the time I got through school and needed to meet those obligations, they had changed the criteria — it was now rural areas only, and I didn't want to do that. But I was lucky enough to have a chief of medicine who directed me to an endocrine lab, and that really changed my life. It made a big difference. I had never thought of specializing. I loved research, but I just didn't think I was going to do it. I spent my fellowship in and out of the lab, then seeing patients and doing clinical research in reproductive endocrinology.

I would advise people, if you have the interest: getting the credentials of becoming an expert in something was extremely valuable to my career, because it gave me credibility — it showed I knew how to do things. The other thing it did for me, which I hadn't looked for but came to realize was really valuable, is that it taught me research. That means: look around you, make a hypothesis, design a study to test it, and then get a clear answer. It's the clarity of the answer coming out of the experiment that really matters. So I did clinical investigation, mostly human physiology, and it served me well when I finally decided to go into the pharmaceutical industry, because I knew how to frame the questions and design the experiments — and to understand that if you design it this way you get this answer, and if you need a different answer, you have to design the experiment a different way.

The reason I ended up leaving the academic career I loved — and this may resonate with many of you — is that I wasn't that young anymore. I'd been at the hospital for 18 years, I had small children, and all of a sudden that quadruple threat of teaching, seeing patients, doing research and, at that time, some administrative work was really difficult with children. In a hospital setting they'd schedule all the meetings outside patient-care hours — really early or late at night — and I was having trouble getting home. I decided that another job with one responsibility might make it easier. I learned quickly that it didn't reduce the hours; it just gave me more flexibility over them. I didn't have to do the early mornings and late nights, but I might have to do a weekend.

I started in industry again in early clinical development, working closely with the scientists discovering new targets and making molecules, helping think through how you'd test them in people and what they'd be most valuable for. I loved that work. I slowly got more responsibility, leading people — and again, credentials really matter, because people trust that you have enough experience to do something. Then comes the next lesson, which is really important: sponsorship. Somebody I'd worked with at my first job, a health insurance advisor who had moved to Novartis, had a headhunter call me because he thought I might be good for a role. And it turned out that the president of the research group — NIBR, the Novartis Institutes for BioMedical Research — was somebody I'd known when I was an intern at Mass General, who thought I'd be good for the job. That kind of sponsorship — somebody watching out for you and recommending you for things — has been a huge part of my success. I call it out because it works both ways: I now have a responsibility to be a sponsor for others, to pull them in and say, "They can really do this."

As you've probably heard, I never started with a piece of paper saying, "I want to be this kind of doctor and get there." It was always serendipity — "That sounds good." I wanted to do something I liked, that was a really important priority, but I was willing to change what I was doing along the way to take on opportunities. So I was offered the chance to change companies and take responsibility for a larger group. After five years, the same president gave me another opportunity: he needed somebody to take over a completely different job I'd never done before — running what they called the program office, which was project management, knowledge management, portfolio and strategy. Now, you just heard me: I'm a clinical investigator, a reproductive endocrinologist. I'd never done any of those things, although I'd worked with people who did. I remember very well the first day the head of HR came in and said, "You do realize you're taking on a role you're not prepared for? You're no longer managing people whose jobs you know how to do. You're managing people you need to trust, and you need a new leadership style."

It was a great place to take that on because I had a lot of support — a lot from HR, frankly, and some leadership-training opportunities. Moving to a place where you're leading a group by vision, not because you're the expert who can tell them the solution — you set a vision of where you want to get to, align with them on how to get there, and then your main job is to support them. You're somebody to run ideas off, to challenge and question, but then to get out in front of them, protect them, and get them the funding and the people they need. That was a really big opportunity that changed the trajectory of a lot of what I did. Even then I missed taking care of projects and patients, but it was a great learning experience. I did it for five years, then got asked to be head of the clinical team at MedImmune, and I really wanted to get back closer to the clinic. That job had clearly prepared me for it. Then we had a change of organization — which happens frequently in the pharmaceutical industry; for those of you thinking about it, it's not something to worry about, it's just inevitable — and I was offered the job of chief medical officer.

So that's the story in a nutshell. There are a lot of twists and turns, but I think there are some principles. One is being open to change. The second is that other people are important for your development. And the third is learning to lead with a vision, and a story of where you're going.

That's a great question, and I didn't believe it at the beginning. I had an advisor who was always telling me that doing things like going to rural Tennessee for blood-pressure screening was a waste of good doctors. It took me a while to understand, but you can be a generalist and be an expert too. You can be a generalist who's an expert in how to screen for prostate cancer, or in how to design a clinic that's welcoming to all and doesn't carry biases, or in advocating for access to care. But I think you need to be special in some way, because otherwise you're just like everybody else — and you need to show you can take a concept and really do something with it. I don't think total generalists are as proficient. Maybe that's snobbery and I'd be happy to have a debate about it someday, but I think it helped me a lot to show that I could stand out and do something.

That's a really good question, and I talk about it a lot, because it was a shock. One of the most important socializations to become a junior doctor is learning to give orders — to assess a problem, say "this is the answer, this is what you do," and to tell the nurses and other staff around you. In industry, you work on teams. In fact, you can't be successful in the pharma industry if you go in with the attitude that you're going to give people orders, because you're working with people who know how to do things you don't. It's really humbling. You have to have somebody who knows regulatory. You have to have somebody who knows how to make the drug — a chemist who understands the risks of the molecule itself. And you need operational people to help you run and conduct the trials. So you learn quickly that you're very dependent on a wide group of people with different kinds of experience to make the product the best it can be.

I was really lucky: I joined at a time when they were doing a major revamp of the training, and I got to be part of it. It was a lot about what we talk about now — diversity and inclusion, and realizing you need all those different perspectives on a team to make the best product. It's both scientific expertise and that perspective. Often the clinician is a de facto leader of the team, because we have a lot of the broad experience — we've seen patients, we know some chemistry, we know basic biology and what the pharmacology studies show. But you need everything, and there are a lot of people who are much better project managers than physicians. So it was humbling, but really exciting, because suddenly you were learning all these things you'd never incorporated into your thinking about medicine before. I really enjoyed it.

That's a great question. I don't lead that way. I lead by trying to inspire and support and hold people up so they can do it. I lead by delegating, and by giving people a development opportunity to take on a new project. I guess it depends on what you mean by being a bad person to lead. You do have to fire people. You do have to say, "I'm really sorry — your performance review shows you're not delivering what I need you to deliver. What can we do about this?" Sometimes it means they depart. Sometimes you find them a different role that fits better. Once we did it by demoting somebody and saying, "You're going to be more comfortable somewhere we don't expect so much from you." So it's not that you're sweet and kind all the time. But if you do it in a way that's unemotional, that's the key — it's the emotion that makes it so miserable. If somebody is mad at you, that's really discouraging. But if somebody says, "I need to give you some feedback — this work isn't what I expected," and you do it in a caring way, you can be a good leader.

I think there are fair parts to it. If you think of pharma as a business that's just selling drugs for way too much money that don't do very much good, then you could imagine why people might think that. But if you think of pharma the way I'm looking at our building right now — huge, with labs, a lot of basic scientists discovering things, understanding how diseases work, finding new drugs, testing them in people, deciding whether they work well enough, and providing new options — then I don't think it's fair at all. What we do in R&D contributes a huge amount to human health. Just look, in a primary care model, at what's happened with diabetes drugs in the last ten years — the SGLT2 inhibitors in particular, and finding out they're actually helping in heart failure and kidney disease. That's a huge contribution. And what pharma companies have done to reduce cancer and improve lifespan with cancer — that's enormous. So no, on the whole I don't think it's fair; I don't think it's a good description of what pharma can do.

It's a great question, because I struggled with it from the beginning of medical school. Is it better to help one person or to help everybody? Of course, that's an impossible answer — you have to help everybody one patient at a time. So I go back and forth. I still try to be really helpful to one person at a time. But of course there's a lot of pride that comes from solving the bigger problems, the bigger impact. And yet every single person is an individual and needs one-on-one care. It's really easy to say, "We should do this," but then you have to figure out how to implement it — and that's done one by one.

Yes. And I lead that way as well. When somebody's struggling, we often just say, "Let's break it down. What can we do right now? Let's do that to get started." I'm also a big believer — and I've learned this over the years, especially with all the IT and digital advances — in the idea of a minimal viable product. Get something out there and see if it works, and then start tweaking it. Don't make this perfect thing with all the marketing and the bow tied first. Get something people can play around with and test, to see if it's the right answer or not. That's a very pragmatic approach.

You're absolutely right. But everybody has a boss — even the CEO has the board to answer to. Bosses, frankly, get more and more critical as you get more senior; they figure you can take it. I mentioned before something junior doctors may not appreciate: the value of good HR support. A good human resources person who's helping you with your hiring will also give you feedback on how you're coming across and the impact of your behaviors. And in industry, from the very beginning, we start taking leadership courses, and those often include 360 feedbacks, where you get written input from the people who report to you, as well as peers and bosses. So over time you get a story about your strengths and weaknesses. I've learned a ton from those opportunities, and I'd highly recommend them as soon as you can get the chance.

The being brave has to do with taking risks. There are two sides to it. One is that you have to know the person — acknowledge they have their own views, and really listen to the perspective they're bringing to the table. And then taking risks is about making that gut judgment: do you want to work with that person, what are you going to do together, and how do you communicate it out there?

I spend a lot of time advising people that, especially in pharma, we're doing experiments. I'm in R&D — I've always been on the R&D side — and we do experiments every time, whether it's a study or just trying a new way of doing something. If you get the management around you to agree, "I'm going to try this, this is an experiment," then there's nothing to be afraid of if it doesn't work, because you laid it out from the beginning as something you were going to try. It gets you into the mindset of, "What are the endpoints? How do you tell if it worked or not?" But it also gets you the buy-in — you didn't take the risk by yourself; others bought into trying it. It's obvious when you're running a clinical trial; it's less obvious when you're restructuring something or teaching in a different way, but you get the idea.

I've learned that you never have all the information — you always have to make some decisions with gaps. I'm pretty analytical about it, in a risk-based way: what's the worst that would happen if we make this decision, and what would happen if we don't? You weigh those two, because you have to take risks and have gut feelings about some of these things. For things I know have legal or regulatory consequences, I spend a lot of time digging in deeper — and obviously if there are huge budget consequences. But for other things I often say, "The risk here is relatively small. Go for it."

Sure. Big failures. The program office job at Novartis — I consider that a failure. We had a change of presidents, and the new one didn't see the value of what we did in the same way. He didn't see the value of keeping it in one organization, and we broke it up into multiple organizations. I felt like a failure that I hadn't been able to convey the value of it adequately. And that leads to another point: people with business training approach these problems completely differently — I don't know if it's the business training or some other exposure. One of my weaknesses has been stakeholder management — really getting out in front of people to say, "This is what we're doing. Isn't this awesome?" I tended to be a bit more introverted, and to assume people would see the positivity on their own. If that's true for anybody in your audience as well: you do need to be a much stronger advocate for yourself. I probably could have done that more strongly over my career.

Oh, I've learned a lot — I'm not sure I can put it into a quick summary. One thing is that when you have a company this big, with lots of people holding different responsibilities, pulling it all together into a single message is a challenge. This person thinks a little bit this way, that person a little bit that way. We use our global communications group to make sure we have an aligned message. This is one place where I really appreciated the value that a coherent communication approach brings, so that we have a consistent message. The other part is that you're responding to real-life events, and things are changing really fast. We had to stay on top of it as quickly as we could, which was often emergencies to manage emerging data — another example where we had to make decisions before we knew everything, because things were coming out as more and more people got vaccinated. We probably could have done a better job as an industry, early on, explaining why vaccines were important. I think that was missed. In the US it was partly fragmented by states, and every country did it differently. There's been so much politics, and it's been really sad. That's my opinion, so feel free to disagree with me.

That's a great question. The sacrifices I made were never doing something I didn't like, or something I didn't believe in. Everybody has to have their bottom line of what they will and won't do. I remember when I took the role at Novartis, my boss asked me what I needed, and I said, "I need to be home for dinner." He said, "Absolutely, you should be home for dinner." If I'd had a boss who said, "Sorry, that's not possible," I probably wouldn't have taken the job. So everybody has to think through what their minimum expectation is. I wasn't the kind of person who sacrificed above all else. I often worked nights and weekends, but if it was somebody's birthday party I was invited to, I wouldn't have worked that night. I know other people who'd make a different choice and say, "I have to get this done by tomorrow morning, so I'm going to miss my kid's birthday party." I wouldn't make those decisions. But everybody has to choose what they're willing to sacrifice, and working long hours, I was willing to sacrifice. There were definitely periods where I got really frustrated by it — feeling unappreciated, feeling cranky. When that starts happening, I have to find a way to take a break, because you have to get away from it sometimes and put your mind somewhere else, to get back the perspective on what's important and what you can prioritize.

Yes. I've found that I do need to take time for myself. I'm not one of those people who can get by on four hours of sleep, so I prioritize sleep, I prioritize exercise, I try to spend time with friends, and I deliberately find time to give my mind a break. I remember one weekend we were working through some vaccine issues, and I wasn't available for a couple of hours — I said, "I've got to go take a walk, guys, I just can't do this." And to talk about it helps, because you're setting a good example for others: everybody needs to take those breaks.

The other thing is that I really try to be positive, and to deliberately express positivity to the people around me — because if I'm negative, my team will be negative, and everybody ends up in the dumps. It's my job as the leader to bring everybody up, to energize them, to provide the stimulus and the lift — not to be the one they're afraid of, or the one who brings them down.

There are a ton of leadership books out there, and I hate to say it, but I don't remember the titles very well. I did think Thinking, Fast and Slow was really helpful — a really different way to think about leadership. Another would be the concept of situational leadership, where you adjust your style based on what the person needs. When it's a brand-new person, you don't assume they know how to do it, and you help tell them what to do. When it's a senior veteran, you don't tell them what to do — you help them come up with a vision of where it's going, and you interact in a completely different way. That was one of the most helpful lessons for me.

Another one I found helpful, which took me forever, was books about negotiating. I always thought of negotiating as this really unpleasant thing until I finally read a book that pointed out that a negotiation is positive for both sides. If you go to buy a car and you take the first price they give you, then they think, "Oh shoot, I'm disappointed — I could have asked for more." If you actually push a little, getting closer to their bottom line, then they're happy because they feel like they started at a good place, and I'm happy because I got a bit of a deal. That concept never dawned on me before — I'd seen negotiating as a really ugly, difficult thing to do. So those aren't books per se, but they're topics for people to look up.

I've been really interested in this concept of diversity and inclusion, and I'm very aware that I was born on the right side. My dad was a lawyer, my mother had gone to college, my grandfather was an engineer — I had lots and lots of support, and expectations put on me. And I was also really lucky that I had men in my family who supported me having a career. I'm a little bit older, so it wasn't quite so obvious then — my medical school class was 20% women — but all the men around me said, "Absolutely, you should do this. You don't need to get married, you can support yourself." So I feel very, very lucky that I had those opportunities.

I know I could have worked just as hard without those advantages and not ended up with them. But working hard, getting into the right schools, getting those opportunities, taking some risks — some of that inherent effort helped a lot too. So it's a mixture. But I'm very aware that somebody growing up with a very different background might not have had the chances that I did.

When I started in medical school, it was pretty bad — professors giving absolutely sexist jokes in the classroom, those kinds of biases. But it was quickly clear that the women were just as competent, so it was more the hostile environment that was difficult; I don't think it was ever a challenge for opportunities. A lot of us go through things and only realize later — "Oops, I hadn't realized that's what that was." I feel terrible about one incident: I was at a party where a guy was making jokes to a woman, and I didn't say stop. The next day there was a harassment case against him. I'd witnessed it and I didn't do anything, and I feel terrible about it. So some of it is about heightening our awareness — sometimes you get that awareness because it happened to you and you know it's not okay, and sometimes other people teach you over time. I tolerated it as just what it was, but in retrospect there were some pretty unpleasant environmental things. Less so, though, a glass ceiling.

It's a great question. As I said, I'm not the best person for the big answer, because I didn't go into it with a vision of where I'd end up — I was always just looking for what was really fun. I would say: talk to people. If you can set a vision for exactly what you want, then find everybody who can help you get there. Get mentors — both senior mentors and peer mentors who've done that — find out what you can, get those introductions, and build that network. If you're like me and you're really looking for something you like, then do a good job at what you're doing, and watch for the opportunities to come along. Sometimes you'll go looking for them because you'll say, "I'm done with this, I need something else" — that happened when my kids were little. And sometimes they'll come to you, and you need to be open to them. Above all, think about what makes you happy, and be sure that what you're doing is something you enjoy. I would say, for sure, don't do it just for the money, please — because you won't be happy.