00:00:00
Voix Off: ''Cent jours pour réussir'' is the podcast from G_NIUS, the Guichet national de l'innovation et des usages en e-santé. Around Lionel Reichardt, meet e-health innovators and key experts to help you succeed in your projects.

00:00:20
Lionel Reichardt: Hello everyone and welcome to the podcast "One Hundred Days to Success" the podcast for innovators and entrepreneurs in digital healthcare, but also for anyone curious about this field. This podcast is produced by G_NIUS, the Guichet national de l'innovation et des usages en e-santé. In this episode, we'll be talking about collaboration with pharmaceutical companies. To do so, we welcome Maryne Cotty-Eslous, founder and CEO of Lucine, a young innovative company in the field of digital therapies working on chronic pain. We also welcome Livia Darmon, in charge of digital and health data at LEEM, the French pharmaceutical companies association. Marie Hello, and thank you for sharing your experience with us. Can you tell us about your training and your background?

00:01:05
Maryne Cotty-Eslous: I'm an eternally curious scientist. I started with law and political science. Then I branched out into the humanities and social sciences, anthropology, sociology, psychology, to end up with my nose in neuroscience and more specifically neurophysiology.

00:01:24
Lionel Reichardt: The ciné project was born in 2013. You founded the company in 2017. What is its ambition?

00:01:29
Maryne Cotty-Eslous: LUCINE's ambition is to create a digital therapy or digital molecule capable of measuring and relieving the pain of a patient suffering from chronic pain, and if possible, as effectively as a conventional drug.

00:01:45
Lionel Reichardt: Where are you today?

00:01:46
Maryne Cotty-Eslous: Today, we started, there were three of us. Today, we're 40. We started with zero euros. Today, we have just over 2 million euros in sales. We managed to convince several shareholders to follow us in a series of parricides for an investment of 5.5 million euros, which is one of the biggest investments in our sector in the last ten years. I'm very proud of this investment, because it's 100% French, that's the first thing, and it's parity. There are as many women investors as men.

00:02:22
Lionel Reichardt: How do you view drug companies? Are they competitors, partners? How have you positioned yourself in relation to them?

00:02:30
Maryne Cotty-Eslous: As partners, as structures that already inspire us. Because from the outset of LUCINE, our vocation was to also become digital pharmaceutical laboratories, so as inspiring partners, as building partners. As we know today, pharmaceutical laboratories are the pillars of therapeutic innovation in healthcare. So we can't do without them.

00:02:56
Maryne Cotty-Eslous: And as I'll say, very benevolent big brothers and big sisters who have from 2016, graciously accompanied us. And I give this example really with a lot of simplicity which is Sanofi, which without taking any shareholding, without any business interest, chose to accompany us for a period of over a year, both locally, regionally and nationally, and enabled us to get to know what pharmaceutical laboratories were, how they worked, but also to structure in terms of business and revenue system.

00:03:32
Lionel Reichardt: How did you know which drug company to turn to? How do you approach them?

00:03:38
Maryne Cotty-Eslous: Good question. How do you go about meeting them? Because they're huge structures and we figure we don't really know which door to knock on. I'd say there are three elements. The first is that when you're starting out, I think you have to rely on your ecosystem. You need intermediaries who can give you access to the right people. At LUCINE, as early as 2017, we had BNP, for example, which was a fabulous intermediary for the Ipsen group and LUCINE.

00:04:08
Maryne Cotty-Eslous: I also think it's important fairly quickly for entrepreneurs who found innovative healthcare companies and want to collaborate with pharmas to also position themselves as experts and be visible as experts in their field. And that means taking part in roundtables as, but as a co-host or as an expert in order to be identified by pharmaceutical companies.

00:04:34
Maryne Cotty-Eslous: And the third element that I think is important is that when you have a product that is strong, with consistent scientific and clinical data and participate well in congresses to present your therapy or your innovation. And it's not you who'll be knocking on pharmas' doors, it'll be the pharmas who'll be calling you.

00:04:52
Lionel Reichardt: In what ways can drug companies accompany you, help you, or support you in digital health innovation? Is it in co-development, in financing, in distribution? How do we work with these companies?

00:05:04
Maryne Cotty-Eslous: What can pharmas do for us? And I'd also like to add what can we do for them? Because for me, it's really something that's based on exchange if we want it to work. Pharmas can help us with phase 2 and phase 3 clinical studies. That's what they do. They've been doing it for decades.

00:05:25
Maryne Cotty-Eslous: So they have real in-house expertise to think strategically about the protocols and typologies of data that need to be fetched. The second thing is that they are extremely gifted when it comes to regulatory and reimbursement strategies. So on innovative therapies, on classic [inaudible], but also, let's not forget, on medical devices. Most of them have DM units within their pharmas.

00:05:55
Maryne Cotty-Eslous: The third element is that they also have regulatory rigor in relation to what we'll call compliance, which brings together three major themes: How you talk to a patient, how you talk to a healthcare professional, how you talk to a public player. There are things you're allowed to do, and things you're not allowed to do. And pharmaceutical laboratories have effectively adapted their marketing, their communication with their structures, their agents, while respecting the law of complacency. And it's extremely complicated.

00:06:30
Maryne Cotty-Eslous: Inversely, what can we do for her? Already, we're experts in our therapies. I think that's important to say. And so, if they come to us, it's because they recognize this expertise and expect it. I think that's the first element. The second element is that we must also have knowledge of our market, of our competition, which must be perfect, and we must be able to effectively share this information with them.

00:06:57
Maryne Cotty-Eslous: The third element is that it's our responsibility to come up with thinking around revenue and distribution systems for our solutions. This is another element that seems essential to me, and one on which these large structures are waiting. Finally, the last element that seems important to me is communication. It's our responsibility to communicate our successes with our partners, and I believe that our partners have real expectations on these different points.

00:07:26
Lionel Reichardt: How do we avoid getting locked into being the little nugget that makes the drug company look nice and digital?

00:07:34
Maryne Cotty-Eslous: There's a first question for me that's important, which is how already, we, are credible and legitimate when we're very small, that we're going to talk to an enormous structure in terms of history, in terms of results and in terms of financial mass too. There's the question of the credibility of smaller companies.

00:07:51
Maryne Cotty-Eslous: That, for me, involves work linked to understanding the codes of pharma and health. And that's the responsibility of the company's CIO. It means providing solid scientific and medical data, both external data, i.e. state-of-the-art data, and internal data, i.e. data from an exploratory protocol or a phase protocol.

00:08:19
Maryne Cotty-Eslous: I also believe, as I said, that in order to be credible and an opinion leader in your expertise, but also, especially at the beginning, you need to surround yourself with opinion leaders who are infallible in the eyes of your structures, healthcare professionals, researchers who will effectively be able to establish the beginnings of the data you offer these structures as a guarantee of your legitimacy, your credibility. And I also think that there's a question about our position here too.

00:08:51
Maryne Cotty-Eslous: I think that when you want to do business with a pharma structure, you have to behave like a business partner, i.e. not like a start-up, but like a young company, but above all an innovative company. And I think there's a real position to be taken that's essential if it's going to work. As an extension of this, I think there's something I'd really like to share today about how things can work when you're from such and such a culture and such and such a universe, different in size, different in financial elements.

00:09:28
Maryne Cotty-Eslous: I think we have to go back to what our common interests are. And for me, there are three major common interests that make it in the interest of big pharma and young innovative companies to work together over the long term. The first is patients, which is what makes a pharma boss stand up today, even if you could say, if you're a foul-mouthed person, that it's [inaudible] his company's or/and the stock markets, that's not true.

00:09:58
Maryne Cotty-Eslous: I think there's another element that's important, and that's the patient. And I think that when you've just come out of a crisis like COVID, you're still not totally out of it in doubt. A young innovative company is exactly the same thing. We come together to offer patients viable, solid solutions that will respond to a symptom or disease, and which will therefore be able to prolong their life expectancy or improve their living conditions.

.

00:10:26
Maryne Cotty-Eslous: The second common interest we have in working together is innovation. I said this earlier. Pharmaceutical companies have always been financial, regulatory and structural players in healthcare innovation. I think the same is true of the pool of young companies, particularly from the world of research, who have a billion ideas a second and who are also promoters of therapeutic innovation.

.

00:10:53
Maryne Cotty-Eslous: And here again, I think the health crisis we're going through today, when you see what happened with vaccine development, there's no doubting the fact that a large group and a research group have every interest in working together. That's what we saw with Moderna, that's what we saw with Oxford. So, I think there's really something going on today around therapeutic innovation.

00:11:14
Maryne Cotty-Eslous: And then, the last element, because we mustn't forget one thing, is when we have an interest that is business. We're here to make cash, because otherwise we can't wait for the two elements of interest I mentioned earlier, namely the patient and innovation. And we have an interest in doing business together. And that's important to say, because we mustn't take pharmaceutical laboratories for portfolios. We need to be in a position where we, as innovative companies and young innovative companies, are business partners.

00:11:44
Maryne Cotty-Eslous: And so, if we have a position as a business partner, we're on converging interests and so we're effectively going to have a funder opposite to whom we're providing a service. We're not in the same position at all, and it's in both our interests that things work out, because if they do, we're both winners from a cash point of view. And that's something I don't think we should forget if we want it to work.

00:12:06
Lionel Reichardt: Is it the same time for drug companies as for young innovative companies in financial and legal terms, isn't it too complicated to work with drug companies?

00:12:16
Maryne Cotty-Eslous: Just like that, without thinking, I say no, it's not very complicated. No, there aren't any incredible legal or financial issues. And for me, pharma time is health time. Reimbursement deadlines, market accessibility, clinical study protocols. So as long as we're in the same market as healthcare, we have the same timeframes, in fact.

00:12:43
Maryne Cotty-Eslous: Me, when I create a BTX, it takes me between six and ten years exactly the same amount of time as for a drug. So, in terms of temporality, I'd say we're in line with reactivity. But it's a little different because there are layers of decision-making that a pharma company will have, and that a start-up company, necessarily with 40 people, won't necessarily have, that's obvious.

00:13:08
Maryne Cotty-Eslous: It's more about response responsiveness. But honestly, most pharmas that are mobilizing to have real business partnerships with smaller companies have managed to bring agility with internal structures that are more autonomous from a legal and financial point of view, today, very clearly.

00:13:26
Maryne Cotty-Eslous: So it's tending to move and on the legal and financial side, quite honestly, you have to get support. That's obvious, as they are. So we want to be accompanied by consultants who can take that position. But it's not insurmountable. Honestly, in all transparency, it's not as hard as raising funds. From a legal point of view. So, most start-ups and young companies raise funds several times over, so if we succeed in doing that, we succeed in doing business.

00:13:56
Lionel Reichardt: To conclude, what advice would you give to a digital health innovator who would like to work with a drug company?

00:14:02
Maryne Cotty-Eslous: First tip, identify the needs and challenges of the pharma you're going to be working with. It sounds very simple. In fact, we do it from the moment we start doing business, from the moment we start selling. You need to know the needs and challenges of the partner or customer you're going to be working with. But we sometimes tend to forget this when we're dealing with huge structures. So it's extremely important for me to identify their needs and issues.

00:14:28
Maryne Cotty-Eslous: The second element, as I said, but it's understanding the codes not of pharma, but of health. If you choose to be a young innovative company that wants to do business in healthcare, you have to embrace the codes. From the point of view of scientific and medical data, rigor and credibility, it's essential. Otherwise, you have to do wellness, and that's absolutely fine. But you have to accept it if you choose the health sector.

00:14:51
Maryne Cotty-Eslous: The third element for me is that there is real mapping work on the maturity of pharmaceutical laboratories to want to create partnerships with companies that do digital. As I see it, there are three stages of immaturity. The first stage is that we can't afford to miss out, so let's communicate and market the fact that we're working with partners, young partners in the digital sector. It's very viable. It's a win-win situation for both sides, very clearly. You have to realize that if it's just communication, it'll never be business. You have to identify that.

00:15:25
Maryne Cotty-Eslous: The second stage of maturity is support. Then there are companies that want to go further and say, "We can do more, we can support you" - Sanofi does it, Pfizer does it, for example. And it's important to identify the people who communicate and provide support. But it's not necessarily a business strategy either. And then, finally, there are the last ones.

00:15:45
Maryne Cotty-Eslous: And there are plenty of Sandoz, Novartis, Baillard, GSK or SUCAF. I can go, there's a lot. It's just to say that things are moving. Bayeusaine who are working on business partnership strategies, either as a companion, or as a donor, or in clinical studies, or sometimes on a standalone basis. You have to identify them and, depending on the cost and objectives of the young company's structure, you have to work with the right choices.

00:16:13
Maryne Cotty-Eslous: And I'll end with two points that I think are important, the first point. I think that when you're in a business that's in the process of being created, which is the case for digital health and which is the case in particular for my sector which is DTX and digital therapies, I think that you shouldn't be apprehensive about reassuring the future partner.

00:16:40
Maryne Cotty-Eslous: You have to have a position in which you reassure, you reassure through data, you reassure once again, I said it through opinion leaders who support your project. We reassure through the way we present information, we reassure through our expertise, and we also have to reassure, I think, about our financial capacity. Again, don't forget that even if you've been in business for a year, two years, three years, if a Pharma wants to work with you, they haven't worked with you for six months.

00:17:14
Maryne Cotty-Eslous: He'll work a year, two years, three years, sometimes even ten years on a project. And we shouldn't underestimate the fact that we have a duty. Here again, if you start out on a three-year co-development contract, you have to be able to show the pharmas that you're financially capable of lasting the three years. And so, the last piece of advice, I think, is really about when you're in a start-up market, company directors have a responsibility, and that's to reassure their partners.

00:17:44
Maryne Cotty-Eslous: And I think that's it, you have to, you have to remember that. The last piece of advice I could give is, and I'll take the liberty of repeating this in terms of a quote from someone I like a lot, whose name is Lionel and who said something very right. Dear CIO, dear founders, dear entrepreneurs, don't wait for pharma. Realize what you can do, and you see in everything I've mentioned, there's not much that the Pharmas have to do, it's up to you to work.

00:18:16
Lionel Reichardt: Maryne Cotty-Eslous Thank you for your testimonial.

00:18:24
Lionel Reichardt: You have questions about working with a drug company. Elements of an answer with Livia Darmon, digital and health data project manager at LEEM, the French pharmaceutical companies. Hello, Livia Darmon. Can you tell us about your background and training?

00:18:38
Livia Darmon: I'm a digital health engineer by training. I also completed my curriculum with a master's ticket in business administration, which I obtained at the IAE de Paris Panthéon-Sorbonne. I began my professional career in the deployment of healthcare information systems, first with a hospital software publisher, then with GCSE Sézanne, which acts as a kind of right-hand man to RS Ile de France on healthcare information systems projects.

00:19:01
Livia Darmon: Then, just before LEEM, I worked at Medicen, the healthcare competitiveness cluster in the Ile de France region, where I was already supporting innovators who were from industry, academia or clinical settings in their digital health projects. So that involved supporting them in finding funding, partners, maturing their use cases or their business model, for example.

00:19:21
Lionel Reichardt: So you're in charge of digital health data at LEEM. What is LEEM? What is your role?

00:19:26
Livia Darmon: So, LEEM pour les entreprises du médicament is the professional organization for drug companies operating in France. It represents 260 member companies. Today, we have 9 commissions, so 6 strategic commissions and 3 transversal expert commissions, including the one dedicated to digital data and new technologies, which I'm in charge of as head of the digital and health data mission.

.

00:19:49
Livia Darmon: This commission today brings together nearly 30 drug companies united around common strategic priorities such as strengthening the positioning of drug companies in the digital health ecosystem, promoting the attractiveness of the French territory in this field, also participating in the implementation of shared health data platforms in very close connection with data, of course, and finally, promote the development of digital culture and skills within healthcare companies via the implementation of a digital health academy project comprises within LEEM, which aims to be a genuine space for skills development and innovation dedicated to the digital health sector.

00:20:27
Lionel Reichardt: Drug companies are players of great interest to healthcare innovators, often for partnerships. What is the place of these drug companies in the world of digital healthcare?

00:20:39
Livia Darmon: Today, our companies have entered what we call the [inaudible] era. This is a new strategy that involves offering, beyond treatments, associated digital services designed to improve patient care, monitoring and care coordination, for example. But we at LEEM, and all pharmaceutical companies in general, are aware that this strategy cannot be achieved without the support of other players in the ecosystem.

00:21:03
Livia Darmon: This is why our companies are today multiplying partnerships, particularly with startups via three modes, either via direct collaborations, or through mentoring support programs that they can set up for these startups. Or. Thirdly, via third-party structures that provide a little go between between all these players, such as Digital Pharma Lab.

00:21:26
Livia Darmon: These partnership strategies enable drug companies to benefit from the strong capacity for innovation that startups have. And in return, these startups benefit from the network of expertise and know-how of drug companies. For example, in terms of the regulatory circuit, drugs, pathology or knowledge of the needs of patients and healthcare professionals, among other things.

00:21:47
Lionel Reichardt: Concretely, when you're a healthcare innovator, how do you go about working that a drug company?

00:21:53
Livia Darmon: So, I'll start with my first piece of advice, which is to start by targeting drug companies working in therapeutic and technological areas that are in line with your project. For example, if your project consists of a support solution for cancer patients, go and knock on the doors of laboratories working in this field.

00:22:11
Livia Darmon: As I was saying, there are different ways of approaching a drug company. I recommend you explore several of them. Also find out how the identified laboratory generally collaborates with start-ups. Is it through third-party structures? Does it have its own support programs, etc.? Etc.

00:22:28
Livia Darmon: Next, another piece of advice I'd give is to clearly identify the place the laboratory can occupy in your corporate strategy and business model. Under no circumstances can your business model be based solely on pharmaceutical support. Similarly, you need to be ready to start a co-construction process with the laboratory, which means freeing up time for possible workshop or mentoring sessions, and also being ready to take into consideration feedback from the laboratory on the project's technical or strategic choices, for example.

00:23:00
Livia Darmon: Finally, the last piece of advice I could give is in your pitch, show that you've carried out an in-depth state of the art of your market who are your competitors after all? What are your competitive advantages and what are their barriers to entry? As you know, the e-health sector is extremely competitive. So, especially for a start-up, you need to prove that your solution is innovative and won't be replicated tomorrow by a potential competitor.

00:23:30
Lionel Reichardt: Our episode is coming to an end. Thank you for listening to us. We thank our two guests for their availability. Feel free to subscribe to the podcast on the listening platforms. We look forward to seeing you soon for a new episode of ''One hundred days to success''.

00:23:48
Voiceover: Those who make healthcare today and tomorrow are on the G_NIUS podcast and all the solutions to succeed are on gnius.esante.gouv.fr