Great Science, Missed Patients: The Next Decade of Biopharma

Christian Soschner00:04:04

Yeah, that’s a good point. Treating disease to preventing disease. I think this is a huge shift in the industry. We had a lot going on this year. What was the topic that worked your mind the most in this year?

Alasdair Milton00:04:18

Yeah, that’s a great question. So, I mean, I’ve been covering the market, either in a market research role or as a consultant for around about 20 years. I started my career at the bench, and we’ll talk a lot about that, no doubt. This is probably the most interesting time and certainly the most turbulent time in biopharma. We’ve got obviously the geopolitical tensions, we’ve got issues around tariffs, we’ve got changes here in the US at the regulatory level with FDA, with cuts to NIH. We’re seeing obviously, I think, the sugar high of the COVID times now kind of settling down again and a lot of companies going out of business in the small biotech world. So it’s been such a turbulent time. It’s just so traumatic, is maybe a little bit of a strong word, but very hard for our clients to try and navigate a lot of these complexities, and that’s why they come to a KPMG to help. So, what’s been on my mind this year is really it’s a little bit twofold. It’s been the disruptive macro environment, but also incredible advances in the science still, right? The science keeps marching forward, it keeps moving forward no matter what. And that’s always what gives me hope.

Christian Soschner00:05:32

Yeah, it’s good the scientists keep working regardless of what happens in the world. But when I look on the public stock market, I think it’s a completely different story. You have all these ups and downs and left and right. And from the perspective of investing in public market, I’m always curious to hear from experts like you what are the trends right now in the industry that excite you?

Alasdair Milton00:05:56

That’s a great question. It’s really hard, I would say, to pick one. This is it’s such an interesting time. If I how do I even pick one in terms of like one or two trends? I remember doing some work 10 years ago in the obesity market. And at that time, it was really dead end. The drugs didn’t work very well, they had significant side effects. And fast forward 10 years, and here we are with the impact of the GLP-1s, kind of opening up that market. We’re seeing obviously a lot of investment from different pharma players now in that space. We’re seeing the emergence of multi-cancer early detection tests, still early days, we have to tweak that technology. We’re using a lot of tests now in oncology to predict disease recurrence and you know help physicians understand, when they should stop therapy, for areas like multiple myeloma. But I think if I had to pick one area that for me is just super exciting right now, and this is an area I tend to spend a lot of time in, is I spend a lot of time around the cell

Alasdair Milton00:07:03

And gene therapy space. It’s we have the first in vivo CAR-Ts. So we have in vivo CAR-Ts in humans, phase one trials ongoing. I think that could be a significant game changer. Because when I was doing my PhD 20 odd years ago, the idea that you could even have autologous cell therapy was almost like science fiction, right? How could you extract a patient’s T cells, re-engineer them in a lab, infuse them back in, and in some cases have a complete remission or cure. But here we are, we have that technology, and now we’ve gone even further with the in vivo CAR-T. So to me, that’s like that’s one of the most exciting things from this particular year to two years for me.

Christian Soschner00:07:44

That’s a good points. You mentioned GLP-1 and CAR-T, and I think both technologies were deemed dead for a very long time. And this is what’s amazing for me in the industry is that innovation doesn’t happen linear in a in a straight line from bottom left, no innovation to upright, we have solved everything. But it’s always this almost nothing for a very long time. And GLP, I think it was GLP-1 1985 or something, where they started, then turn it down, brought it back, turn it down, brought it back, and suddenly you see the spike. Kati, pretty much the same. Why is the innovation? I want to hear your opinion, why is the innovation in our industry, in the biopharma industry, not something that you can predict on a linear scale. It’s just a left, right, linear, every year a little bit of progress, and we know what’s coming. Why does it happen in a way that is a straight line, almost nothing, and then suddenly it works and we get the results and it really changes the world for the better?

Alasdair Milton00:08:38

Yeah, I it’s a great question. You know, I think you could almost tell it in the story of gene therapy, which at this the early 2000s there was a lot of promise in gene therapy. And then there was a trial where there was a death, and that kind of killed that field for a number of years. We couldn’t optimize the dosage with the AAV vectors. We were seeing significant liver tox issues, and those still plagued that market, but that death in that clinical trial in the early 2000s really killed the field for a number of years, and yet it came back because we spent time tweaking the technology, the scientists went away, they figured out how to you know maximize the payload without the tox side effects. You could almost say it was the same with the antibody drug conjugates. At that time a number of years ago, ADCs, nobody was really investing in that area. It was very difficult to manufacture. You had chat problems with the linker technology, with the payloads, but we spent time. We tweaked the technology, we improved the manufacturing, and the science advanced. And so here we are, ADCs again, super hot area that everyone is investing in. So I think it’s just those incremental things. You take, you know, a couple of steps forward, one step back, and then you take another couple of steps forward, and then so the science keeps evolving, the science keeps maturing, and I think eventually we get there.

Christian Soschner00:09:59

Yeah, absolutely, totally agree. The progress is long-term incremental, and you need to push people to keep going, move forward, give them money, give them capital, help them moving forward, and then suddenly you have this great wow moment because we have regulation, everything’s approved, and then the markets take it up, and also marketing. You mentioned cell and gene therapy. You’re excited about this area and this excites you the most. Why did you decide for cell and gene therapy?

Alasdair Milton00:10:26

So let’s split them as well because people say cell and gene therapy, and I don’t I don’t like to say that. They’re very different. That should be cell and it should be gene. They’re their manufacturing is different, their in markets are different, the patient population sizes are different. So let’s just split them a little bit. But I think in both cases, what really excites me about those spaces is the idea that we can actually give patients a functional cure in many ways. So if you think

Alasdair Milton00:11:00

About gene therapies in that space, they’ve really they’ve really kind of changed the dynamic and they’ve given a functional cure to a lot of these patients who had no other options. And on the on the cell therapy side, we’re seeing you know, complete remission often with a lot of patients in multiple myeloma with some of these autologous cell therapies. So that’s what’s really exciting to me is the idea that we can actually have a cure in many cases, which in other disease areas, even in oncology with the antibody drug conjugates with a lot of the new technologies, you give patients a little bit more time, but it’s very hard to cure them. So cell, the cell therapy, the gene therapy space to me are just very, very exciting.

Christian Soschner00:11:45

Yeah, absolutely. And we have some challenges, but we dive into that later. A lot of topics you mentioned that elect in the preparation, you’re wording that the US potentially will lose or might lose its innovation ground. China is an upcoming market, precision medicine is moving forward, and now today you’re in the United States, but it didn’t start there. Can you share the story where it actually began?

Alasdair Milton00:12:11

Yeah, sure. So I was born and brought up in a very rural part of the west coast of Scotland. When I say rural, it’s a small island, it’s called Seil Island, S-E-I-L. It’s about 15 miles southwest of a town called Oban, which, if anyone who’s watching this is a whiskey fan, is a very famous whiskey town in Scotland. And so Seil Island is, I don’t know, a couple of miles wide, three or four miles long. It’s a population of about when I was growing up, there were maybe three or four hundred people. So very, very small place. My dad was a fisherman, my mom worked in the local school, solidly blue-collar. And you know, my dad especially was very focused that I would go to university, was actually the first one in my family to go to university. Clickling down, rolling up your sleeves, and you know, just go for your dreams, just try and you know, push on, push hard and try and achieve your dreams. I loved growing up on that island, it was incredible, but it there comes a time when you feel like you’re a little bit it’s a little bit claustrophobic and you have to go out into the big bad world. How was life on that island for you as a kid? Idyllic, really. It really was. It was a great upbringing. Great friends. The kind of place where during the summer holidays, your mom and dad would kick you out of the door at eight o’clock in the morning on your bike, you’d go and play football with your friends, come back at five o’clock, and you know, very safe. It was it was a great place to grow up. So I’m very it was very, very lucky. But like I say, you I think you eventually, I still have friends who live on the island who stayed around that area. I think you know some folks just never wanted to leave, and there was other folks like myself who just felt they wanted to go out and do other things.

Christian Soschner00:14:09

So and you finally left the island. But before we dive into what comes next, let’s stay a little bit on your early life. I think today, when many people grow up in big cities and are fully connected, and I assume we are pretty much the same age of Gen X experiences, the 70s and 80s and 90s, pre-internet era. What lessons can you take or did you take from your childhood with you that served you well as an adult up to today?

Alasdair Milton00:14:42

So I think there’s a level of tenaciousness in me, in particular, and kind of discipline, like I said, and resilience. I did a lot of swimming when I was a kid. So when I was about eight or nine, I started swimming competitively. I so I would have to be in the pool at you know, six or seven in the morning, four days a week to train, and then at the weekends I would swim competitively around Scotland. You’re that young, it takes a lot of resilience and dedication. It’s not easy to get up at that time in the morning, especially on the west coast of Scotland where it rains a lot in the in the winter and it’s very dark in the mornings, but you know, I would have to do that, and then I would go to school afterwards. And so that definitely has a lot of discipline and you know, I’m just somebody who has that very level-headed approach to life and believes that you know you work hard, you keep your head down, and you know, you’ll like I say, you’ll achieve your goals. But definitely that discipline, that resilience, that tenacity, which actually really helped me a lot when I went to university and I did my PhD. Because again, those qualities are required when you’re in the lab and you’re in there, 80 hours a week sometimes, you’re not earning much money really, you’re working weekends. And so a lot of that grit and determination that I took from my childhood actually translated very nicely into you know what I did at university.

Christian Soschner00:16:15

Yeah, totally. Reminds me of my own life. The generation 70s, 80s had the excellent work ethic. Get up in the morning, get your job done, don’t think much about it, come back the next day, regardless of sunrise is 5 a.m. Or 9 p.m. 9 a.m. Yeah, just get the job done. In your opinion, when we look at today’s world, I mean I have always this discussion between work ethic and discipline is the most important part in building a successful biotech company. When we look at it a bit outside biotech, NVIDIA, for example, is currently the prime example of Jensen Huang with his excellent work ethic in Hustle, Hustle, Hustle. And then on the other side, they hear very often hustling is not everything. When you look at your own life, how important is discipline, in your opinion, for success and having a solid work ethic?

Alasdair Milton00:17:10

Critical, I would say, especially as a consultant. You have to be so well organized, you have to be disciplined in your life as a consultant, you have to be organized. You have to have a good work ethic. This is not this is not a nine to five job. You have to be willing to make sacrifices, you’re on the road a lot, you work weekends, you’re in client services. And I think at the end of the day, that discipline, that work ethic, that organizational, the organizational skills that are required are absolutely critical. Yeah, you’ve got you’ve got to be willing to really grind. You’re a partner in a Big Four, you’re contributing to the partnership. And so you wanna you wanna be you want to be a good partner, and so you know, everyone has to roll up their sleeves. So that hard work ethic is absolutely required in your in your in your career, no doubt. Absolutely no doubt.

Christian Soschner00:18:02

I would like to stay a little bit on this area. Discipline, work, ethic, and resilience. This is a free password that very often come together. And then it’s the question from kids about where can I learn that? How do I get that? Where do I find these skills? You said that you were a competitive swimmer in your school. Is sports, like being a competitive swimmer, helpful for developing the skills?

Alasdair Milton00:18:29

I think so. I don’t think it just has to be swimming. Swimming is a little bit of a almost a unique sport in that you’re on your own, right? So you have to have all the tenacity. But also you’re a team player, right? I swam as part of a team. But I think any sport can instill that sense of teamwork, hard work, just resilience, tenacity that’s required to be successful in the business world. But I also think you sometimes you can’t teach that. I think it’s almost in your DNA. I don’t know if it’s just because of the background I had and you know the fact my mom and dad were so focused on pushing me through my education and instilling me the idea that you know go to university, get a good education. I think that it comes off, I think a lot of it comes from your parents as well. So I think it’s a little bit of the DNA, but it’s also yeah, sure it’s also a little bit about the sports or the extracurricular activities as well.

Christian Soschner00:19:37

Yeah, they served you bad. You mentioned that then later you did your PhD and your first consulting jobs. Could you could you rely on that skills then in these jobs?

Alasdair Milton00:19:51

Could I take what I learned and translate into the business world? Yeah. Sure. I think moving from a PhD into the business world though is that was one of the biggest jumps for me, was actually going from the lab into the kind of corporate world. You’re in the lab, you’re very focused on, a particular mechanism or molecular path where you’re in the weeds, you speak the science,

Alasdair Milton00:20:20

Okay, but then that’s different from then moving to the business side because the language is different, the goals are different. And I think sometimes I see this even in the work I do today is in the big pharma companies that I work with, the left hand of R&D doesn’t take talk to the right hand of commercial, right? And so they speak a different language. And so that was actually one of the biggest jumps for me was that move from the lab over into the corporate world. And so while some of the skill sets are transferable, again, the discipline, the work ethic, there are other things that you have to learn. I think that’s almost just learning on the job. When I actually moved from the lab very briefly, I was a sales rep for Wyath, right? So that shows how many years ago that was, back in 2005. And so that helped me just cut my teeth a little bit, understand a little bit more about the business of pharma. And that’s what helped kind of propel me into the other roles that I had.

Christian Soschner00:21:17

I think this is an interesting point that you mentioned you worked as a PhD in a lab and then jumped into big pharma basically in 2005, pre-social media world. Yeah. This is something I see frequently in biotech. So they have a good idea, start in the lab and then move into the corporate world. Why is that so challenging for people? How different are they? Can you explain a little bit the life in the lab for you as a PhD candidate? And then how life changed when you were at the big company?

Alasdair Milton00:21:49

Yeah. So again, I PhD, right? You’re

Alasdair Milton00:21:55

You’re a specialist in a particular area, right? You’re in the weeds. You’re very detail-oriented. You’re very focused on particular mechanisms, pathways,

Alasdair Milton00:22:07

Your area, right? So super, super deep and not very wide. And then you go and you try and, go into a marketing role or a sales role in a pharma company where, like I say, it’s a different language, the drivers are different, they’re more focused on business outcomes, on ROI, on speed. And those are things that also quite often you don’t have in the lab. So that while there are some transferable skills from the lab to the business world, that to me was one of the biggest jumps was just learning that new language, learning about learning about companies, right? How are companies structured? What’s a P&L? What’s a balance sheet? What do we think about cash flow? Those aren’t those aren’t anything that you’re ever exposed to in your PhD. So yeah, it was it was a significant jump. But I had a great, a lot of great mentors and folks who helped me out in that transition. So I was very lucky. But I would say I really cut my teeth in my first job beyond what I was a sales rep for a little bit and then I moved into a market research firm, and that’s when I really started to cut my teeth in the in the pharma industry, and that’s where you know that’s when my career kind of started to really accelerate.

Christian Soschner00:25:11

Let’s stay a little bit with your PhD before we dive into the corporate world deeper. I read in your Vita and in your material that you not only worked in the lab, which you’ve always thought it’s more than a full-time job, but you also had some jobs beside it. How did you manage to do that?

Alasdair Milton00:25:33

With great difficulty. Yeah, it is you’re right. Look that the PhD stipend is, I think, gosh, mean was maybe $15,000 back in I started in ’99. So not a lot of money, right? You really don’t have much money. It’s I mean a PhD, you have to be so it has to be something that you’re really passionate about. Like that cannot be something that you get out of bed every day and think, oh my goodness, I can’t go to this lab again and do this all over again. If that’s the case, get out. Because the pay is terrible. And so I had to supplement that meager income with site jobs at the weekend. And I remember often working in the lab Monday to Friday, full days from I don’t know, six, seven in the morning till six, seven at night. And then I would go into the lab and maybe a Saturday and a Sunday morning, I had some experiments running, I had to do some stuff there. And then I’d go and do a sales role. I had a sales job working in different stores in Glasgow, just to earn a little bit more money. So yeah, I mean you but you do these things. It’s if you have that passion and that drive, then I look back, I was never unhappy, right? We didn’t have a lot of money. I just got married as well, so we don’t have a lot of money, but you were happy. It was it was and I just I had that passion, and I had that drive, and I think that really helped. And that and again it came back to the discipline. And be willing to just roll up your sleeves, right? Nobody’s gonna hand you something in life. You gotta just go for it yourself. Take the risks.

Christian Soschner00:27:13

Yeah, no, I totally agree. And I think this is a brave example. We can use it for a clip then later to cut it out and present it to the topic. How do you get resilient exactly that way? You find something you’re passionate about and you just keep going and do what’s necessary.

Alasdair Milton00:27:27

That’s why, like, why do why are a lot of biotech founders successful, right? That passion, that drive that they have to take that science from the lab out into a company, grow that company, and either exit through an IPO or sell onto pharma or whatever it might be. But you’ve got to have that passion. You just have to be successful.

Christian Soschner00:27:45

And it keeps opening doors for you when I sum it up, what you said. You worked in the lab, were passionate about your area, didn’t make much money, but closed the gap with side hustle. Then you mentioned that you were already in a sales position on the weekend, besides your PhD, which might have played a role later that Big Pharma then says, Yeah, we want this guy. He understands the science, and he also holds for the first time in his life sales skills.

Alasdair Milton00:28:11

Yeah, I mean it’s so just to back up on that story, when I when I left my PhD, I actually applied for a job at this market research firm in Edinburgh called Wood Mackenzie. They had a small life sciences team, some research analysts that I ultimately became one of, and then some consultants. Then they had a huge oil and gas part of the business as well. I actually applied to them before I got the sales role at Wyeth and was rejected because I had no experience. Oh and this that was tough, right? Because it there weren’t many jobs like that in Scotland. It was just such an interesting company to work for, and so it was really crushing to not get that job the first time. So that’s why I went away. I got the experience with Wyath, and then I went back to Wood Mackenzie a second time and got and got that role. But again, it’s just that tenaciousness.

Christian Soschner00:28:59

So yeah, dealing with rejection is an important part in sales, I guess. Yeah, definitely. But then when you look back to your material, you didn’t decide to sort of stop as a sales rep at Wyeth. You moved to Boston in 2007 and into a life science company. How was that?

Alasdair Milton00:29:20

Yeah, so I left in 2005. I briefly worked with Wyeth, and then I applied back to Wood Mackenzie and was taken on by them a second time in later on in 2005. And so I worked there, like I say, they had a small life sciences team. I was one of the research analysts, so I was responsible for covering different companies top to bottom. So, what’s their geographic strategy, their business development strategy, their deals? We did a lot of forecasting work, doing financial analysis. And then they offered me the chance to move to Boston in 2007 for just a two-year second. They were growing the US practice and they needed some folks here. And so they offered me the chance to move over just for a couple of years, but things didn’t really work out that way. We arrived here in it’s actually October of 2007, so just around about 18 years now. And within just a few weeks of arriving, they pulled all of the life sciences team in and announced they were shutting the life sciences team down entirely. They weren’t even going to sell it, they were just gonna shut it down. Pre-laymans, so the market was doing pretty well. They had just been acquired by a private equity firm and the oil and gas team, the oil and gas side of the business is doing really well. Life sciences was a small part of the business, it was maybe 10% of the revenue, and they just decided to close the whole thing down. So that was pretty crushing when you’ve moved your life three and a half thousand miles, and then within a few weeks, you’re out of a job.

Christian Soschner00:31:06

I can imagine that this was a tough time. You look forward to new continent, new country, new challenges, and this decision. Usually, I think people don’t make it lightheartedly and say, Oh, well, I tried and two weeks later I don’t care about it. What I would be interested in to hear from you, I think this these life-changing moments when you look forward to something and when you really appreciate a move forward and then suddenly things change. Many people are in shock and need a very long time to process it. What did help you? What techniques did you develop to process the shock and move forward?

Alasdair Milton00:31:43

That’s a great question. Yeah, I mean one of the biggest lessons I took was that your career is never linear. And that you find that one door closes and naturally another one opens. And it when that door closes at the time, it can seem like the end of the world. But when I look back now, it was probably one of the best things that happened to me. If I hadn’t lost my job at Wood Mackenzie, I’d probably have gone back to the UK and I probably wouldn’t be here at KPMG doing the work I’m doing. So in many ways it kind of worked out well. But again, I keep I feel like I’m like a broken record here with the resilience and the tenacity. Like I’d always wanted to come work in the States, right? That was my drive. I didn’t necessarily want to live here forever, but I was willing to go on a two-year-second. And that was just so exciting to me, right? The idea that I could come here, be exposed to new culture, learn some new skills, and then take that back to the UK, fantastic. All of a sudden that’s closed on you within just a matter of weeks. And so again, I come back to the tenacity, the resilience. And if you have a drive, you have a goal, you’re gonna say, okay, that’s not, I’m not gonna let this be the end of the story. And so ultimately the life sciences team, the research side of the team at least was bought out by a company called Decision Resources. And I started my new job on the 1st of January 2008. So within just three months of arriving in the US, I’d lost the job, got a new job. And then that was a big decision, right? My wife and I had a big decision to make. Do we go back, right? You know, do we go back to the UK? Do we try and start somewhere else in the UK? We wouldn’t have been able to go back to Scotland because that job had gone. It was probably gonna have to be the southeast of England, which is another that’s a big change as well. Or do we stay here? And do we go with decision resources and try and make a life of it here for the next few years? And so ultimately we decided we would try and make a go of it. And it was not easy at all. We spent a number of years where my wife in particular struggled. She was a or is a nurse. She had worked in she’d always been an oncology nurse. She had worked in the in the UK at the beats in Glasgow. And so she had to give up her job because her skill set here they wouldn’t accept. She had to retrain. And so she was out of work for a long time, and so it was really tough on her. And so it was a it was a tough few years. You don’t really know anyone, you don’t have that many friends, but again, it’s just that resilience and that push and that drive that’s kind of just in you that kind of pulls you through, I think, a little bit.

Christian Soschner00:34:24

Yeah, and you mentioned broken record. I think we can’t play this broken record over and over again and not in not enough times. This is exactly how you how you become resilient for later in life. You need these challenges, people need these challenges in life, overcome hardships, and the next time when something happens, they just stay cool, relaxed, calm, because they know I have all what I need to move forward.

Alasdair Milton00:34:49

Yeah, I don’t have a lot of patience for people in life that want to just be handed things. No, it’s not in my DNA, it’s that Scottish grit and determination that kind of pulled us through. So, things worked out well in the end, but it was a it was a tough four or five years, I would say.

Christian Soschner00:35:08

Yeah, beautiful said you mentioned Scottish grit. Why are Scots famous for that?

Alasdair Milton00:35:16

I don’t know. I mean we’re a nation of emigrants. Most I think I don’t know how many people in the in around the world can claim Scots heritage. I know there’s a significant number of US presidents that can claim Scots heritage, but you know we’re a nation that’s always pushed out of our own comfort zone, our own four walls. Significant number of folks obviously left throughout the 17th and 18th centuries to go to Australia, Canada, US. We’ve always been a nation of immigrants. Andrew Carnegie, who was one of the most successful businessmen of all time, was born in Dunfermont in Scotland. So I just I think we’re just we’re a nation that likes to go and explore, see what’s outside of our own country, some sometimes by choice and sometimes not by choice.

Christian Soschner00:36:10

You were quite exploratory, you started on a small islands, PhD in adap, went into sales, market research, and then into consulting. Yep. How was that for you to transition from one role to the next? It’s a wide variety. How did you decide to make such jumps? How was that for you?

Alasdair Milton00:36:35

Yeah, so when I came to the US and was with Decision Resources, I ultimately ended up leading that analyst team. And so I evolved in different ways as well. So I went from an individual in a lab doing my thing to learning to be part of a team at Wyatt and then at Wood Mackenzie and learning the business. And so you learn new skills, you mature, you evolve. And then I came here and I took over the analyst team at decision resources, and so I became a leader. And so I had that opportunity to evolve into that role and to kind of develop my skills. And then at that point, I felt that I wanted to do more work that was directly client-facing and very impactful. And so that’s when I decided to move over, move over into more of the direct consulting roles. So, but at each stage of that journey, there’s been the evolution and the learning new skills and embracing the opportunities as well, right? Not being scared to take on new things. I think sometimes people are scared, they feel that, hey, I’ve got imposter syndrome, I can’t step into this role or I’m not good enough. And I always say, just go for it. Just go for it. Again, I could easily have quit when I first came here after I lost that job and said, you know what, I’m done. I’m gonna just go back to the UK. And you know, if you’ve got that drive and that focus and that tenacity, then you just you just keep going. So I but I’ve learned, I continue to learn, right? Even as a partner in a Big Four, you’re never done learning, right? And that’s critical because that’s what helps you be a good partner, and it was what helps you be a good consultant to your clients.

Christian Soschner00:38:20

I couldn’t agree more. Passion is more important than skills people can learn, but hard work, passion, resilience, this is all about mindset, and it’s not hard, it’s not easy to teach. It’s really hard to find people with the right mindset. Yep. When we look at your career, what person had the most impact on your life?

Alasdair Milton00:38:45

I’m gonna say my wife. Yeah, I am. I’ve had I’ve had some phenomenal mentors. I’ve got I’ve got great mentors here at KPMG, and I’ve had great mentors through my career. But when terms of who’s had the most impact, I think it has to be my wife because she didn’t really want to leave Scotland. She’s very close to her family. It was tough for her to leave. You’re quitting your life. She quit her job, like I said. She’s having to give up her job to move to a country that she didn’t hadn’t been to before, that she didn’t know anyone. I’m out working here in this new role, and she’s stuck in the apartment, she couldn’t work. At the time we didn’t have kids. And so she sacrificed a lot. She really gave up a lot. And then for her, when we decided to stay, to then try and retrain, right, which was tough. It was very hard for foreign nurses to actually successfully train over here and get their the qualifications again. But she did that. She took on other part-time jobs, and now she’s one of the oncology nurses in the oral chemotherapy unit here in the Dana-Farber in Boston. So you know she’s pushed on hard, she’s kind of she’s made a lot of sacrifices. So I wouldn’t be here in this role if it wasn’t for her, to be quite honest.

Christian Soschner00:40:14

Congratulations, great journey, great journey that you did together from Scotland to Boston, United States, and just keep going.

Alasdair Milton00:40:22

You just keep going, just get your head down, keep going.

Christian Soschner00:40:24

Never give up. Never give up. That’s true, that’s a good attitude. Yeah. When we look back at your career at on your life, what was the hardest moment in this career for you?

Alasdair Milton00:40:38

I think it’s gotta be I think it’s gonna be that three-month period when we came here and things fell apart. It was absolutely it was devastating. Because you have left behind your friends and family, and you’ve come to this country that you know you don’t know anyone and you all of a sudden are cut adrift. That was a really tough time. That was a stressful time. My wife and I were we’re actually talking about it the other day because it’s it was but just about the 18th year I’ve ever seen since we came here. And we were talking about how I she went home for Christmas that year, and I had to stay here and trying to figure out like this new role. Should I move over to decision resources? You know, what’s gonna happen, what does the contract look like? Just a lot of stuff going on, and eventually got back to the UK in like Christmas, I think it was the 23rd or 24th of December. Her birthday is Christmas Eve. So I’m landing back in the UK. I have to like take a I think I ended up taking a bus from like Heathrow up to Glasgow. But so that period was just really hard, like some big life choices. You have this fork in the road almost, and you don’t quite know which way it’s gonna go. Like, what happens if you make the wrong decision? So that to me was definitely the toughest time. Yeah, because you’re impacting someone else’s life as well, it’s not just me.

Christian Soschner00:42:06

So I think what’s what is interesting for me, diving a little bit deeper in these decision-making situations in life. You have a tough time, you have many roads that open, you can throw the towel and say, No, I go back to the UK, to Scotland, and I’m done with the United States, you can decide to stay in the United States. Other people very often what I see give just give up and say, Okay, it’s useless, it’s senseless. I don’t like it. What kept you going? What habits or mind trick did you develop to keep you going through such tough times?

Alasdair Milton00:42:47

I think we sat, we I mean we really sat down and thought carefully about the different paths. I don’t I think the sure I could say the tenacity and whatnot. And that was definitely like I really wanted to stay here. I didn’t want to have to go back to the UK because I really couldn’t see a path forward in my career if I went back to the UK. Right? Because what I was what was it, what was I gonna do? I just lost my job, I was gonna have to reapply for other jobs with other companies. It was gonna be really hard, we weren’t sure we could even live. Or we stay here and we try and just tough it out and we see what the next year brings and then the next two years. And so you it’s hard. I’d love to sit here and say that I planned the last 18 years, but I didn’t. I just thought, okay, let’s give it six months in the US or a year. Let’s see how it goes. Where are we? Are we happy? Yes, no. Do we keep moving on? Let’s do the next year and the next year. And so things just snowball from there. That was kind of how we approached it. I we just couldn’t see a path forward for us in the UK. It just wasn’t gonna work for us. So to stay here, you’ve got the opportunity of this new role, and let’s just see how it goes. Do you enjoy it? Do you start to make friends here? Do you start to put roots down? And then when we had our kids, I mean that’s a game changer as well. So our first daughter was born in 2011 and our second in 2013. So, that’s when things start to kind of snowball, and you’re like, okay, we’re gonna be here for the foreseeable.

Christian Soschner00:44:23

So congratulations to your family. They are now 10, 14.

Alasdair Milton00:44:30

12 and 14.

Christian Soschner00:44:31

Yeah, yeah. Yeah, so it’s still in school, still in school.

Alasdair Milton00:44:35

Still in skill.

Christian Soschner00:44:36

Yeah, exciting times. The points that you mentioned are really good. Give it some time. So, this is what I take with me from what you said. When you go through tough times, give it some time. Don’t throw in the towel too early. Don’t give in to temporary emotions. They don’t last forever. Sometimes they change.

Alasdair Milton00:44:58

Yep. And you look back and realize that sitting down with a cool, collected head and thinking through the options and thinking logically and trying to put the emotion to one side, that will pay dividends.

Christian Soschner00:45:13

But is that easy? Fear, hard emotions in such a situation. How do you turn off your mind? I turn on your mind and turn off the emotions.

Alasdair Milton00:45:25

I think you just have to lay the options out in many ways. For me, it was a case of good the good and the bad. Like what were the what was the good and the bad of going back to the UK and what was the good and the bad of staying here? At the end of the day, let’s say we so we decide to stay here and we don’t like it after six months. For a year. I bought myself some time to think about the path home to the UK. Right. But if I make a snap decision, I go back to the UK, I’m landing back there, I have no job, I don’t know where I’m going to live. What am I going to do? Right. So to me, it was it was pretty straightforward in many ways. I had to really kind of see this through. I didn’t think back in 2008 that I would still be here 20 odd years later. It was just that journey that we that we took. Could quite as easily have just blown up after six months. But at least I had the time then to think about what was the path. You know, that was the logical part. That was the logical part of me as a scientist and the way I just process information and make decisions, right? Just sit down and think in a in a cool, collected, and calm manner, if you can, about what do the different paths look like and what’s the best option.

Christian Soschner00:46:35

But this is one of the most important skills in business as well. When people ask, how can I create a successful company? There’s always an up and down. This is it’s never a straight line. But when you know how to survive the hard times, with as you said, just sit down, brief, think about it, lay out the options, make a decision, move forward. But also on the upper side, when companies are super successful, it’s so easy to get lost in emotions, excitement, everything’s new, and then the decline comes. This is such an important lesson.

Alasdair Milton00:47:08

And I think there’s another important part to this, which I think was relevant for our situation, also for business leaders, is take good counsel, listen to other people around about you who you trust. You know, I didn’t just make that decision along with my wife. It wasn’t this very narrow decision of just Alasdair and his wife making this decision. We spoke to friends here, we had some folks here who we knew who had been here for a number of years and who had come from Scotland and were in the business world. And so they were good at giving their advice. We obviously spoke to family about the options as well, but take good counsel. Like the best leaders that I’ve come across are the ones who surround themselves with good advisors who can help them guide the decision making.

Christian Soschner00:48:05

That’s a very good point. And is it still valid in the LLM world? I think so. Yeah. So we need the humans at the end of the day. Human advice is irreplaceable.

Alasdair Milton00:48:23

Yeah, I do. I still I still think I mean we’ve made huge advances in that area over the last few years, but I still think you need human advisors who can who can give good counsel. Let’s see where that takes us in the next five or ten years. But at the moment, I still think that the human voice is still is still trusted so much and is required. You know, machines can help inform some of the decision making, but at the end of the day, I think it requires the human voice.

Christian Soschner00:48:56

I totally agree. I think you had this replacement all the time before in innovation cycles, internet. But at the end of the day, we need the humans. Let’s move forward in the conversation. And then your current final destination is at KPMG, and you run a team there. What is your team doing at KPMG?

Alasdair Milton00:49:21

What am I doing at KPMG? Well, let me let me just back up and talk a little bit about KPMG overall in case there’s anyone on the podcast that’s not familiar with the firm. So we’re one of the Big Four. So we’re one of the Big Four accounting firms. We have three kind of main parts of the business. There’s tax, there’s audit, and there’s advisory. So I sit in the advisory life sciences team. And within that team, we do a number of things for our clients. So we help them, first of all, transform their business. So that could be through new technology or just making their operations more efficient and run better. The second thing we do is performance improvement. So we kind of help them optimize top and bottom line growth. The third thing is we help them with their strategies, which is a broad term, but that could be anything from market entry, identifying new targets to acquire. It could be product launch, it could be portfolio optimization. We do a lot of work around ways of working, so helping different functions work more effectively together. And then a large part of what the team that I’m part of does is deals, right? So we help clients either buy or sell parts of the buy companies or sell parts of the business. So we’re with them through the entire process. We do all the upfront due diligence, operational, financial, commercial, IT, HR, right through the deal lifecycle. We help them integrate the new company once the deal’s done, or we’ll help them carve out a piece of the business of if they’re selling and divesting a piece of the business. And we work with pretty much everyone in the life sciences world. So we do work from the with the smallest biotechs to the biggest biopharma companies, med tech labs, academic medical centers, diagnostic companies, life science tools. And the other thing, it’s also global. And so we are roughly six and a half thousand people in healthcare life sciences globally in the firm. So it’s a significant team overall and globally. And that’s important because we do a lot of international deals. And I often describe us as a boutique inside a Big Four, so my specific team. And the reason is because we’re staffed people like myself who have very deep scientific backgrounds. So obviously, myself with a PhD in cancer research, we have medical doctors and staff. A lot of us started at smaller specialized boutique consulting firms, which are fantastic places for initial training because they go incredibly deep in the science, but they’re not very wide. And that’s why a lot of us eventually moved to the two Big Fours and to larger firms, is because we wanted that exposure to the international aspect of work, the truly transformational corporate work. But I think that boutique mindset is actually really a key differentiator for us because we come with the scientific background, we can translate it into business reality for our clients. And our clients don’t want just advisors are going to show up and tell them what they already know. They want to be hire us, to be challenged and to bring fresh ideas. So that’s what I do here at KPMG.

Christian Soschner00:52:46

When we look at your clients, when should someone reach out to KPMG, to your boutique firm inside a bigger firm? What are the events that usually trigger reach out to you?

Alasdair Milton00:53:02

That’s a good question. I mean again, we’re a huge organization, right? So if a client has a specific challenge around tariffs and understanding supply chain issues, that’s not what I do, but there’s someone in our team who does it. And that’s the beauty of the Big Four, like having that skill set, somebody who can talk that specific need. I think it goes where I typically do a lot of my work is in the pure strategy space. So helping biopharma companies launch new products or improve ways of working, or if they’re entering a new therapeutic area, help them think through portfolio optimization, obviously do a lot of the deal work mostly on the commercial due diligence. What the triggers are is very client-dependent. Again, we work across the entire spectrum. So each of those clients has a different need. You know, our big biopharma clients right now are grappling with the onshoring of supply chains and the impact of tariffs and the uncertainties around the IRA. And so their problems are a little bit different from, say, a life science tools company that might want to carve out part of its business to redeploy the capital and then again if you look at like the small biotech. So every client’s a little bit different. I’d say they each have different needs. But we always have someone in the four walls of KPMG that can support them.

Christian Soschner00:54:33

Your team must have an excellent experience. You mentioned that you had a variety of roles before KPMG. And in KPMG, you not only work with big pharma companies, but also with smaller biotechs, so you really have a holistic overview about the entire value chain from labbench to the market.

Alasdair Milton00:54:53

Yep. We do. Yeah. Look, we support our smallest biotechs, and it could be we’ll help them think through the equity story for capital raise, we’ll help them think through valuation services, we’ll help them think through tax implications, we’ll help them for IPO readiness. Obviously, we could we could be one of their, we could be their auditor. So that’s you know, a specific set of offerings we have from the small biotechs, and then we’ll help you know them grow, transact. Maybe they’re they go on the sell side and they sell to big pharma, we’ll work on that deal. And then for a big pharma client, again, it’s a completely different set of needs, but we’re able to see the end-to-end, right, of the whole ecosystem because they all interact, right? This the ecosystem is supported by the small biotechs that you know get that funding, they grow, they transact either through IPO or they exit through IPO or through acquisition by big pharma. And then we have the ecosystem of the life science tools companies that support the ecosystem, the med tech, the labs where the tests have to be run. So, an interconnected web of different companies with different needs at different times, but we’re able to support that whole ecosystem. So you’re quite right. We see we see the whole 360 degrees of the life sciences market.

Christian Soschner00:56:18

Yeah, and companies need it. I find it this is one of the parts that I find so fascinating in the biopharma industry. It starts in the lab, basically, in basic research and science, and it’s a whole unique ecosystem in this space, in the academic world. And then when people have the idea to move, it doesn’t matter if it’s a diagnostic or a drug, more towards the patient. When we say it’s drug development, you come into pre-clinical development. And we just see it broadly. And it’s a complete new ecosystem, and it needs people like you who can translate that and say, look, you have no challenges, then clinical space the same. Then you have regulatory short period, and then you have this market scale up.

Alasdair Milton00:56:59

Yeah, yeah. And you know, helping clients be grounded through the through what we’ve seen, right? We bring such a diverse range of experiences. So we’re able to really help guide clients based on the good and the bad that we’ve seen as well through the years. But yeah, being able to help them grow and transact and evolve and bring different people from the firm at different parts of that evolution of the company. I think that’s the power of a firm like KPMG. Yeah, and that’s why that’s why I came here.

Christian Soschner00:57:38

Yeah. I’m curious, how do you how do you do that? How do you translate this deep science and the scientists into public market boardroom strategy? How does that work look like?

Alasdair Milton00:57:52

Yeah, that’s a great question. So let me let me ground it in a in a project I did a few years ago. It was a mid-sized pharma company that was looking to acquire a gene therapy company. This pharma company had zero experience of gene therapy. This is back when gene therapy was a very hot area and everyone was looking to acquire and get into that market. And so we were brought in to do the commercial due diligence of the target. And so you’re all of a sudden faced with a pharma company that doesn’t really understand the space and its executives don’t necessarily understand the opportunity. But you have this very complex science. And so you have to be able to translate that in a way that you can communicate the opportunities to the executives in a very simple manner. And so we all we actually almost started with a 101 of what gene therapy was, right? So we had to kind of lay out for them this is what it is, this is how it works, these are the headwinds, but translating the science into a headwind or a tailwind for them. So, for example, AV manufacturing, like what does that mean for your business? It means you’re gonna have to set up a new type of manufacturing, it means you’re gonna have to, think about, this is manufactured in this country, okay, but it’s then gonna have to be shipped to another country for fill finish. What does that mean from a tax perspective, trade and customs? But being able to translate all that into a very simple business framework was absolutely critical. We actually started almost with like a 101 of what gene therapy was, but again, it’s it

Alasdair Milton00:59:31

It is that skill set of translating the science into the business implications, right? Because, okay, here’s the science of this gene therapy. It means you’re only going to have a certain number of patients who are going to be eligible. What does that mean from a revenue perspective? What does it mean to have new skill sets that you might have to hire? What does it mean from a manufacturing and a cogs perspective? So yeah, again, that’s the beauty of coming from the bench and now being on the business side is that you can translate that science, but it does have to be done in a very simplistic manner, but framing it around the implications for the business.

Christian Soschner01:00:05

Let’s stay a little bit at this point that you mentioned. I see this very often that it I don’t think it’s well understood. You mentioned you have a complex science on one hand and academic writing, it’s clear it’s a skill set and it’s an environment. And then on the other hand, we need to explain it in simple terms when it comes to business strategy and public market strategies and boardroom strategies. And I very often see that it’s a little bit confusing. So, why is this complex science? Why do we need to simple it practically down for people when they all have their PhDs and basically are in a good position to understand its science? From your perspective, why is this simplification in the process so important in business?

Alasdair Milton01:00:49

Because most of the time you’re not presenting to folks with PhDs and who are not scientists, right? You’re presenting to the CEO, the CFO, the COO, who they will typically have MBAs, they’ll have finance backgrounds, they will not be deep in the science. Even investors sometimes who you would think sometimes would be really deep in the space, but depending on the sophistication of the investor, they don’t necessarily know the science. So that’s why it’s so important. And I almost come back again to the big pharma right hand, left hand of R&D and commercial, and I see this just all the time is that disconnect between the scientists who have this shiny object that they’re very excited about, and the commercial team that says that’s gonna be really hard to sell, or that test isn’t gonna work, and here’s why. And yet the two just can’t always seem to meet up and kind of and decide on a path forward. That disconnect is palpable. And so that’s where we help bridge that gap, right? Is to bridge that gap between the science and turn translating it into the commercial impact.

Christian Soschner01:02:01

Yeah, that’s a very important, very important task to move forward. There’s no business without the commercial side, and it’s completely missing in science initially.

Alasdair Milton01:02:09

Yep, exactly. Yeah, I mean, I think sometimes the scientists do get cut too caught up in the next shiny thing, and that’s great. But unless you have a business reason to move it forward, unless you have a commercial opportunity there, that’s really tough. That’s why some of the best leaders in biotech are the ones that have the science background, but also have the deep training and then the understanding of the business implications.

Christian Soschner01:02:37

Yeah, and I totally agree. I think this is a unique difference between European mindsets and the US mindset. When you look at the board of Europe of US companies, you see the business skills attached to the science. And when I look more on the European side, it’s very often more scientific, which is a very interesting dynamic. And people who want to be successful with a drug towards the market need the business side. It’s pretty much simpler. Yeah. When we look a little bit ahead into the future, shaping the future of biopharma strategy in the next five to ten years, where do you see it going? Do you mean from a personal perspective? From the perspective of your team from a team at KPMG.

Alasdair Milton01:03:23

Yeah, I can probably I can probably frame that in a in a in a way that is around what we’re doing right now. So let’s say you’re a large pharma company today. Like I said, that they’re dealing with just a lot of uncertainty. Talked about the tariffs, supply chain issues. They’re trying to navigate very complex cross-border deals in places like China. They’re facing huge patent cliffs. They need to use MA to refresh and fill those pipeline gaps. Internally, there’s a lot of cost cutting going on, a lot of layoffs, a lot of right-sizing the organization. They’re thinking about how they maybe launch new complex therapies like cell and gene therapies, precision medicines. They’re grappling with things like embedding AI and being more digitally aware, how they embed digital solutions across the company, how are they going to make R&D more productive? So it’s a it’s this huge list of very complex sort of interconnected problems that a lot of these biopharma companies are grappling with. And quite frankly, those are the areas that we’re working in right now. So when you ask me how are we shaping, what do we think about the strategy in the next five to 10 years, we’re already doing it, we’re already in there helping them with these big problems. And I think again, I come back to the power of a firm like a KPMG, where I can pull in people from any parts of the firm to help. So if it’s about supply chain, I’ll bring our supply chain team. If it’s about tariffs, I’ll bring our trade and customs and our tax experts. If it’s somebody, it could be global, it could be they have a question around the China market or the Japanese market or somewhere in Europe, I can tap into our network there. Coming back to the smaller emerging biotechs, it’s a different journey. You know, like I said, we’re with them from the very beginning. We help them craft the capital story, provide the valuation accounting support, get them ready for an IPO. So we’re their partner through the entire life cycle. So when we think about shaping the future of biopharma strategy, we’re kind of already doing it in many ways, really a lot of the work right now.

Christian Soschner01:05:30

Yeah, you mentioned this is pretty much, in my opinion, one of the big advantages of companies like yours, like KPMG. There’s always the question why working with KPMG? Why working with a big company? And the unfortunate thing in life is, I mean, we can write down strategies, but then reality happens, and there are always these shocks like we had with COVID, suddenly the world shuts down. And your advantage, in my opinion, is that you have a global team operating in all regions of the world in different industries, in all aspects of these different industries, and across different functions. So when you have a challenge, you can pull from this wealth of know-how from people who worked in different similar situations, can pull them together, talk with the customer about the problem, and come up with ideas that you have already seen in other industries, in the same industry, somewhere in the world, and connect the dots for them. This is really amazing what you can do.

Alasdair Milton01:06:30

Yeah.

Alasdair Milton01:06:31

It’s we’re a huge organization. I think, like I say, six and a half thousand just in healthcare life sciences. I think maybe three hundred thousand globally. If I’m right there, $30 billion organization. It’s a it’s a huge, it’s a huge forum. And so yeah, I mean, there’s there are people here who do very esoteric things, right? They just they just do one specific area. Could be related to HR, could be related to IT, but that’s the beauty because I can tap into that network. It’s not always me who has the answer, but I know there’s someone else in the forum who does.

Christian Soschner01:07:10

What I’m curious to learn, based on this what you just said, how do you approach a problem with your team?

Alasdair Milton01:07:20

I’m an old school type consultant who likes to sit down and whiteboard problems with my team. I and I that’s coming let me take a step back. It’s much harder now that we’re all a little bit more remote. It’s been harder post COVID. I was taught I grew Up in the idea that you’d all sit in a room, whiteboard the problem, break it down into its different pieces, hypothesize, test a hypothesis. That’s become harder post-COVID, obviously, because we’re all a little bit more remote. But certainly in KPMG, we’re all back in the office pretty much full-time because we recognize the value of being together, right? Being together in a room, solving that problem for the client. So we’ve pushed hard to bring our teams back in person. And I think that’s been very helpful for our junior staff as well, who are now the emerging consultants, to understand how do you take the client’s problem, break it down into constituent parts, hypothesize, test the hypothesis, come back. So that’s I would say been a good thing over the last year or so from the firm’s percept perspective is to bring a lot of our folks back in person. But a lot of our work is done using external interviews as well. So we’ll go out to the market, we’ll speak to KOLs, we’ll speak to different experts in the market, whether it’s payers or physicians or pathologists or whoever it might be. We’ll run a lot of those research external research campaigns to then test the hypothesis. We obviously do a lot of secondary information. We have proprietary databases internally as well. So where I sit in the precision medicine team, we created a proprietary global database that surveys over a thousand oncologists and pathologists and asks them about different tests, the types of tests they’re using, the machines are being run on, are they using large NGS panels, small NGS, PCR, whatever it might be? And so we have access to a lot of that proprietary information. So it’s a it’s a mix of the proprietary, the external, the primary research, the secondary, and then bring it all back together to break that problem down and get the solution for the client.

Christian Soschner01:09:39

Yeah, good points. There was one cue that I would like to pick up this remote working and working in the office. I have my opinion about the topic. I would like to hear dive a little bit deeper into that because I think it’s really important to understand for people why some things cannot be done remotely, but people need to come together in the office. I would like to hear your opinion on that. Why do you think the office work still has a place in this world that’s now interconnected? Why is that important?

Alasdair Milton01:10:10

For a number of reasons. Okay, we just talked about from a team perspective. It’s been really hard for our junior teams who came into the firm during COVID and were all remote to get a connection with their peers and with the leaders in the firm. It’s just a human need, right? To it’s almost like an osmosis, right? You learn through osmosis, you learn from being together. There are things that, if

Alasdair Milton01:10:37

If somebody’s sitting next to me, they can just lean over and ask that question. But if I’m virtual, they’re gonna have to call me up. So I think there’s that whole piece around just that human connection and learning from one another and being close to one another and being able to ask questions. From a leadership perspective, it’s important to show junior staff that you’re in the office, that you are a leader, that you’re there, you’re accessible. But also from a from my perspective as one of the partners in the firm, hearing from my peers, what are some of the opportunities they might be getting from their clients? Right. So if I’m in the office and I’m speaking to someone in our accounting advisory services or tax practice, being present and being with them in the office, I can pick up some potential opportunities for other work there and doors that they might be able to open. So I think that’s why the in the in-person to me is so important.

Christian Soschner01:11:34

Yeah, I totally agree. The team has to play together, and it sometimes feels like downloading when someone is in the office and just listens to people. It feels like they download the information. And when I look at the industry, we had an extremely great time from 2020 to 2022, everything went up, and then came the huge fall, the correction from 2022, and it lasted, in my opinion, until 2025. When you look at the deal environment today, how is it evolving in biopharma from your perspective?

Alasdair Milton01:12:07

Okay. So let me frame this. I’m gonna pull up just a couple of slides to help frame the discussion. I can talk a little bit about big pharma and also what we’re seeing with this the small biotechs as well. So let me just pull up a slide here that can help drive the discussion. Okay, so I think if we’re looking at big pharma, I think the key thing to really understand is that the industry is facing a really huge patent cliff. I think it’s something like 200 billion dollars is at risk in terms of the sales between now and 2030. So pharma companies have to do deals to fill to fill this gap. They have to fill the pipeline. So with this chart here, let me just explain what we’re looking at here. I know there’s a lot going on, but every bubble represents a deal done by one of the top 20 pharma companies since 2019, and it’s tracking up until the end of Q3 of this year. So the size of the deal is represented by the size of the bubble. So a couple of caveats. This is this is outright ME. It’s not any kind of partnerships or R&D collaborations, it’s outright ME. And it’s only transactions over 100 million. So what we’re looking at here are the deals that were done by those leading pharma companies over the last seven years by phase. So where the phase represents the most advanced asset in the deal. So if the target had one commercial asset and

Alasdair Milton01:13:39

They had one phase one asset, we count it as a commercial deal. And so you can see that in 2024 and to some extent 2023, the deals were going earlier. So phase one and phase two, and the value of the deals was higher, was pretty high, even in preclinicals. So, you can see there was no deals done at all for marketed assets in 2024. Now, 2025, as you can see, it’s a little bit different, most notably in the fact that we’ve seen more acquisitions for later stage assets in 2025 versus 2024. I think the biggest one so far this year was the J&J acquisition of Intra-Cellular, which is a CNS company for around 13 or 14 billion at the start of 2025. And so we’ve seen a little bit more of a focus in 2025 on those commercialized or kind of near commercial assets in kind of phase three, late phase three. But what we’ve also seen in 2025 is a continuation of the price paid for early stage assets has been pretty high. So we’ve seen some pretty big numbers paid for very early stage companies. An example would be AbbVie acquired an in vivo CAR-T company called Capstan for about $2 billion. That assets in phase one. Then also in the in vivo CAR-T space, AstraZeneca made a billion-dollar acquisition of a preclinical company called EsoBiotec. And then J&J just recently, just in mid-November, they acquired a company called Halda for about $3 billion for its phase one prostate asset. And it’s a platform company as well. And I think that’s an actually really important point is that a lot of these early stage acquisitions that Big Pharma is making right now, they’re not single asset companies, they’re platform deals. So it’s not like Pharma’s going to spend a billion dollars on a single asset company. They’re buying on platforms that they’re hoping can produce multiple new molecules. Now, there’s another feature of some of these deals, and that’s the fact that a lot of the acquirers are de-risking in many of the cases by building in milestone payments, can contingency value rates. So if you look at the MA of early stage private companies in 2024 and 2025, so those that hadn’t yet finished phase two, and so they didn’t necessarily have proof of concept, around half had contingent payments attached. But they also vary. So J&J paid, I think, 85% up front with just a 15% contingent on its Proteologix deal last year. Novo paid around 30% up front with the majority of the deal value tied to earnouts with the Cardior deal in the spring of last year. So I think the bottom line is the pharma market, the deal market is definitely back, particularly in the last few months of 2025. We’re seeing more commercial or late-stage deals in 2025 versus last year, but also a continuation of pretty significant amount paid for early stage companies, especially those platform plays. And in a lot of the 2025 deals, we’re seeing pharma kind of de-risk by tying the total deal value to some clinical and regulatory milestone. So that’s the story on the on the pharma side. If we shift to the biotech market for a second, let me just move this forward one slide. For the private market, the story I think is really for biotech is really about bifurcation between early and late stage investment. So I’ve been looking at the numbers for early stage financing, so seed and series A in the US and EU, comparing the first half of 2025 to the same period in 2024, which is what we have on this slide. Now, the second quarter of this year, we really saw a huge drop-off in seed and series A investment. The first quarter actually looked pretty healthy, but if you if you actually scratch the surface and you look at the data, it turns out that was mostly due to a handful of mega deals. So about $2 billion of the capital came from just six deals. And that really skewed the picture. And then we came to Q2, the funding just dried up. You know, I think in large part due to a lot of the geopolitical noise that investors really do not like. So, early stage biotech is in a really tough spot. I think from where we sit in KPMG, we’re seeing VCs, they’re still looking at preclinical companies, but they want to see I and D enabling studies, or ideally, that those studies are done. They’re looking for companies that have their CMC in order, especially if you’re in a complex modality like cell and gene therapies. They’re favoring what I would think of as more experienced C-suites over first timers. I think that’s a lesson from the kind of sugar high of COVID, where we had a lot of companies form up that, frankly, did not have the right management teams in place. They didn’t always have good science either. So, what we’re seeing in the private market is investors really reserving a lot of that capital for later stage rounds, Series C and on,

Alasdair Milton01:19:16

Companies that are less risky. I think the capital right now is probably chasing the top 10 to 20% of companies. It’s looking for phase two companies that have got really good management, good science, maybe even have a pharma partner on board. So, look, if you’re a founder and with an idea and no data, things are, I think, really, really tough. And then if we look at the private market or sorry, the public markets, I think if we’d been having this conversation in the middle of 2025, I’d say we’re in a really bad place. The XBI, which is the biotech index, is actually up 50% now versus the middle of 25. I think one of those reasons is that interest rates are falling. So that makes the cost of capital for these biotechs a lot lower. I think companies are finally getting some reward for good data readouts. I think the MA activity that we’ve

Alasdair Milton01:20:08

Been talking about is acting as a tailwind for the public markets. You know, we’re seeing some successful drug launches for a lot of these biotechs, and that’s helping to boost the stock price. And then I think lastly, a lot of the weaker companies that were formed during COVID, they’re no longer there. They’ve flamed out. I think that helps the sector move a lot higher overall. So, look, all this being said, the IPO market for biotech is still way down, right? In September, we got the first US biotech IPO since February. That was a company called LB Pharma. They raised about 300 million. So we’re seeing one or two companies go public, but you know, nothing like we saw a few years ago. And I think a lot of biotechs are still thinking that the smart exit is through acquisition by Pharma rating go out to the public markets or partnering with Pharma to get that capital infusion as well. So, overall private companies, it’s mostly de-risked companies with solid data and management. They’re again the dollars. I think it’s much harder for those early stage that you know have no human data. And I think on the public market side, we’re seeing what I would think of as tentative signs of recovery. But you know, IPOs are still way down, and I think you know, things are still really fragile. So it probably wouldn’t take much to send the XBI back down again. So that’s kind of what we’re seeing from the pharma and the biotech in terms of the deal trends. Let me just take these slides down as well for a second.

Christian Soschner01:21:34

Love the slides there, great. Can you can you pull it up again? I have a few questions to that. Sure. You said we have one or two IPOs, so it’s we need to start somewhere, and it’s good that the IPOs are coming back. Can you go on the first slide? I think just from my understanding, if I read it right, it looks to me when you look at 2015, there were a lot of late-stage deals. So approved, phase three, and up to 2021, phase three deals, late stage deals, and it looks to me a little bit less phase two, phase one deals. Looking at later years, 2024, 2025, it looks like pharma did start to go a little bit earlier. Do we read this right? Is this really the shift that we see here?

Alasdair Milton01:22:19

Yeah, I think for the most part, definitely in 2024, we saw things go early. You can see here there were there were no there were no commercial stage deals by the top 20 pharma companies in 2024. We’ve had a couple so far this year, and we had a couple in 2023. I think it comes down to a few things. I think, first off, the higher volume of commercial stage deals in 22 and 23, that probably left just a relative scarcity of available kind of de-risked assets. I think that probably drove up premiums for their target, attractive targets that were actually left. And I think that means that acquires are maybe a little bit worried about overpaying. I think secondly, I’d say we saw a little bit more of an activist leadership at the FTC in 2024, and that may have contributed to acquirers being a little bit more wary of large kind of commercial or late-stage deals. And I look, I think thirdly, I think it comes down to the need for pharma companies to access innovation and their ability to access that innovation at a lower price versus when a company has more advanced assets. And then you can de-risk by building in those milestones I talked about. And then I come back to the platform comment I made before, but I think by acquiring early, big pharma has the chance to access these, really cutting-edge technologies like in vivo CAR-Ts or RA platforms very early. And you know, we’ve seen multiple deals and in those areas in 2025. I think that backs up that hypothesis. So I think that’s the kind of shift we’re seeing. Let’s see what 26 looks like. I certainly don’t think the deal making for 25 is over and done with. I think we’re heading into JP Morgan. It’s gonna be it’s gonna be pretty busy, I think. So let’s see how the rest of the year and early part of 26 you know plays out.

Christian Soschner01:24:13

Yeah, I like the explanation. I think you mentioned all the important parts that you need data, platform, good management. And when I look at the graphic, the question that pops up in my mind is these are these are deals. In what areas do you see the capital flowing currently? What are the hot areas?

Alasdair Milton01:24:33

Yeah. So look, I think from a therapeutic perspective, it’s probably not surprising to a lot of folks on who are viewing the podcast that oncology continues to get a lot of investment. Also neurology, immunology, and actually cardiometabolics. I think companies overall are focusing more on a core set of therapy areas and they’re going deeper and avoiding kind of spreading their bets across multiple therapy areas. I think oncology is, I think, a roughly half of all the deals. It’s a therapy area that always attracts investment for obvious reasons. You have huge unmet need, you have very clear regulatory pathways, you have premium pricing. So oncology always gets the line share of the deals. And neuroscience is having a resurgence, it’s having a little bit of a moment. We mentioned the J&J Intra-Cellular deal at the start of the year. That’s to date that’s been the biggest deal so far. But there are others. There was the Lilly acquisition of a company called SiteOne for its pain portfolio. Cardio is interesting. We saw a kind of more kind of traditional deal with the Novartis acquisition of a company called Anthos for its blood thinner, but also on really the really cutting-edge side of cardio. There was the Lilly Verve deal for a gene editing technology for atherosclerosis. And then we’re seeing companies obviously execute a lot of MA and a lot of partnering in obesity. We’re all familiar with the recent Pfizer Novo battle to win Metsera. So you know, metabolics, huge area right now. And then rare disease always, again, just is always there as well. We’re still seeing a lot of interest. So, similar to oncology and rare disease, you have very clear reg pathways, premium pricing, and huge unmet need. And then on the technology side, we talked about in vivo CAR-T. What’s interesting with that space is not just oncology now, it’s autoimmune. We’re also seeing investment in RNA therapeutics and then technologies like ADCs, bi-specifics, and then there was the recent Novartis–Avidity deal for technology called the antibody oligonucleotide conjugate. So, kind of precision medicine and advanced therapies, I think, are really front and center in a lot of the deals this year.

Christian Soschner01:26:54

Yeah, that’s good to know. I think it’s important to understand in what direction pharma is looking when companies are in development. There is another question that popped up in my mind that you would like to ask. Thinking back to the pandemic 2020-21, it looked like everybody is investing in pharma and in biotech and in biopharma, no matter how early the deal is. And then the whole market collapsed, and it looked to me like everybody’s pulling out. We see it’s pharma, less deal activity, private equity, all the tourist investors just went back. And now we are at the bottom. My question to you is when you look at all the actors in the industry: big pharma, venture funds, private equity, public grant systems, do you already see a lasting shift in their behavior that points upwards, or are they still a little bit in a in a in a questionable territory where it can go up and down? How do they act across the value chain today?

Alasdair Milton01:27:54

Yeah, that’s a really good question. There’s a couple of actors I’d kind of call out. I think one stakeholder that’s been stepping in recently a lot more, especially as we see the more traditional VC pull back, is the corporate venture arms of big pharma, right? So most of the big pharma companies have corporate venture teams. I think they’ve been investing earlier in recent years. I think between the between Novo, Sonofi, and Lilly, they’ve invested in around, I think it’s about 45 or 50 private rounds in 2025. That was only about, I think, 10 or 11 in 2022. Now, unlike traditional VC money, the corporates don’t rely on outside funding to raise new capital. So they’re taking it from the parent organization, it’s a steadier source of cash. That really gives them almost a lot of freedom to have more of a longer-term strategy rather than just focusing on the kind of quicker returns that the traditional VC stakeholders look for. I think the fact you have corporate venture involved also makes biotech companies look attractive when the IPO. And I think it’s something like 70 or 75% of all biotech IPOs since 2022, they had at least one corporate venture invested. So I think it’s a sign of validation for other investors. They know pharma’s in there, they’re looking at the signs, they like what they see. I think the downside to having corporate involved is that you’re tied to the strategic direction of that pharma company. And so if there’s a change of strategic directing direction of that company, that may mean that your science is no longer a focus for them. But overall, I’d say corporate funding has been really important, especially the way the private markets are right now. And then with private equity, that’s a really interesting one. It’s a really interesting dynamic. You know, even when With R&D spending kind of slowing down and uncertainty on government funding. Private equity clients are really leaning into a lot of these clinical solutions. They see clear opportunities. So as trials get more complex, especially in areas like oncology, biopharma companies are relying more and more on outsource partners. And so the PE firms are investing heavily in those service providers, the CROs, the C DMOs. They’re targeting everything from real-world data providers, specialized software, complex manufacturing companies as well. And so the key takeaway for me is that

Alasdair Milton01:30:17

While the macroeconomic picture is still a little bit shaky, those PE firms are largely looking past the noise, the short-term noise, and they’re focusing on those longer-term growth opportunities. Now, what’s really surprising is seeing PE get into kind of traditional drug development, which that’s historically been not an area they played in. It’s been off limits. So you have the biggest players now, like Carlyle and Blackstone. They’re raising really huge funds dedicated to this. So Blackstone is using its capital for some creative deals. They have a risk sharing that they did with Sanofi for Sanofi’s cancer drug, Sarclisa, where they funded, Blackstone funded $300 million towards the clinical development of a subcutaneous formulation of the drug. And in exchange for future royalties on that formulation, in exchange for the royalties, sorry, and in on the on the in the formulation for future sales. And so that’s a really smart way to get in, I think, on the upside. And then earlier this year, we saw a company called Carlyle take a gene therapy company called bluebird bio private. I think Bluebird had amazing science. They really struggle with the commercial side. It’s relaunched as a company called Genetix, and they’re hoping to fix the manufacturing and the commercial execution. So it shows a new level of engagement from PE. I think PE is hesitant to play in the very early preclinical stages. It’s just too risky for their model. I think that’s where you really see the venture capital step in and fund the initial science. That’s where I call out about where we’re seeing a couple of the actors playing at the moment.

Christian Soschner01:31:56

There’s a lot of positive science, so pleasantly surprised when we sidestep a little bit on deal structuring and deal making. I know from my audience that many scientists who start a company now come into a situation for the first time in their lives to do a deal. And what they do generally is going to a seminar and they learn structuring a deal process. And in theory, it’s always simple. Deal process is a deal process. But when we look in reality, in practice, every company, every acquisition target, and every transaction dynamic, in my opinion, is different. But correct me if I’m wrong. And you and your team, I mean, you’re involved in a tremendous amount of deals and have really good insights. What’s your read on how biopharma companies today are approaching transactions in reality and not theory?

Alasdair Milton01:32:49

Yeah, that’s a good that’s a good question. And you’re right, every everyone’s a little bit different. There are some commonalities though. Yeah, every pharma company’s got different strategic goals, but I do think there are some key trends or some key things that we see that they’re looking for. I think first off, they’re looking for best in class or first in class assets. But even if you have first in class, if it’s a really competitive environment, the pharma company, they want to see differentiation. Now, whether that’s scientific or thinking about the patient population, so can you expand the addressable population beyond the initial indication? For best in class, I think it goes beyond just safety and efficacy. It’s also things like pricing and convenience. I do think it’s really important for biotech companies to have a really considered, very careful plan in place and not rush from one milestone to the next. You know, think ahead carefully. We see companies get Series A funding, then they try and get to the next value inflection point really quickly. You know, that can be a big mistake because if a future farmer partner has to come in, sees things they don’t like, and they potentially have to fix those issues. So I think you’ve got to have a very clear vision for your program as well, even if it’s its early stage. I think it’s helpful for the farmer partners to understand how are you thinking about the impact of things like the Inflation Reduction Act on your company’s assets. I think you have to be able to very clearly articulate your thesis and your path to market, including your differentiation, spend time understanding the competitive environment and where you fit in, because these are areas that any pharma company is going to hone in on. And then I think especially for complex modalities, by specifics, ADCs, cell and gene therapies, scalability in manufacturing is really critical. Pharma clients are laser focused on this. That move from great science to commercial product in those complex modalities that’s so heavily reliant on manufacturing scale. And so pharma companies are looking for very robust CMC plans, realistic timelines. I think another area that gets overlooked is IP. We’ve seen a lot of deals fall through because of issues around intellectual property. So you have to have that in order. And then to be honest, Christian, I think one of the things that we see is that it’s really important. Do you have the right team in place? So we talked about that COVID sugar high when we saw those companies form up that didn’t have good science, didn’t have good management. Pharma companies are really focused on that now, and they want to know that they have the right team in place and the right partners driving the company. So, I’d say overall for pharma, when they’re looking at these deals, it comes down to first in class, best in class, obviously sound science. And if you if you have clear clinical data, that’s fantastic. You got to have a well-articulated story that’s got a very well thought-through, very methodical approach to your milestones and your future market. I think pharma partners are looking for potential partners to have a point of view on the macro environment and what it means for the portfolio, how they’re going to scale manufacturing. Do they have the right IP in place? And then do they have the right talent in place as well?

Christian Soschner01:36:15

Thank you very much for outlining this. This is so important to mention that at the end of the day, I mean, you have to build a business as a company if you want to be an acquisition target. And you mentioned all the important points, and this is so great to hear from your perspective what it takes to move a company forward into acquisition mode. When I go back, I have taking another note that I think is interesting to explore a little bit further to what you said before the overall situation on the market. When I when I listen correctly and understood you’re right, we see deal activity going up on the farmer side, but you mentioned also that we see fewer IPOs, so more acquisition, fewer IPOs. And in combination with that, less venture capital deployment. How do you interpret this entire environment when we look into the future?

Alasdair Milton01:37:11

Yeah, so I think it comes down to almost like a swing from a kind of boom biotech market a few years ago to something that’s we talked about this earlier, something that’s much tougher environment for biotech today. So, in speaking with friends and clients in business development at pharma companies, big pharma companies, a few years ago they couldn’t get biotech interested. The private and the public markets were booming. We had dozens of biotech IPOs, the XBI index was flying high, and so all the leverage, if you like to think of it like that, was in the hands of the biotechs. Now things are very different. And so pharma has much more negotiating powers. We talked about a little bit ago. Biotechs are starved of cash, VCs are much more reluctant to invest in seed in Series A. That capital is going to a smaller number of later stage deals. And I don’t necessarily see that changing anytime soon. I don’t think that in the next year or so we’re gonna be back in a spot where all the power is in the hands of the biotechs, especially now that the macro environment is acting as a headwind to biotech company creation and survivability. So for me, I think we’ll gradually see a few more IPOs in 2026. It’s not going to be anything like it was a few years ago. And I think we’ll continue to see a lot more partnering between pharma and biotechs to enable that cash infusion into the biotechs to keep them going. And I think we’ll see more of those kind of built-on MA. So I think right now that swing is very much towards the pharma companies.

Christian Soschner01:38:48

Yeah, looks like looks like. We covered the microeconomic side, how companies are built, what’s happening on the market. And there was one point I like to explore a little bit more with you that you mentioned briefly. It’s the macroeconomic factors that also influence corporate development and what’s going on the market. It’s inflation. We have a different situation in the US and in Europe, interest rate changes that influence that. And you also mentioned geopolitics that play a lot of influence. Yeah. How do you see these factors that are currently going on influence investment decisions in the life science industry?

Alasdair Milton01:39:27

It’s critical. It’s the policy and economic environment is absolutely critical. You know, one of the biggest factors that we didn’t really touch on is the Inflation Reduction Act. It’s called the IRA here in the US. It’s a real game changer. It allows the US government to basically directly negotiate drug prices. The issue is it creates a much shorter revenue window for small molecules. There are certain provisions in the IRA

Alasdair Milton01:39:54

That means that for small molecules, they have just nine years versus 13 years for biologics. And so that means that companies are more likely to invest in biologics versus small molecules. It also means it really pressures the companies to launch in larger markets first because you want to maximize your return before the price controls kick in. That puts drug development in areas like rare disease at a disadvantage. We actually saw a noticeable drop in new clinical trial starts right after the IRA was implemented. And that’s just that’s just one headwind. So the industry, we’re all familiar with the impact of the tariffs, we’ve got high interest rates. They are gradually coming down. We’re seeing cuts by the Fed that are bringing those rates back down. There’s the geopolitical instability, the cuts to NIH funding, there’s the upheaval at the FDA. So it’s a really tough environment. But there’s opportunities in there as well. You know, things are getting interesting. We focused on MA in our conversation earlier, but we are seeing a rise in the number of strategic R&D collaborations that allows pharma to kind of de-risk investment instead of doing an outray acquisition. So there’s a clear focus on assets that are already in clinical trials, tapping into the growing Chinese biotech market. I think another opportunity we’re seeing is big pharma spinning off their non-core assets. They’re looking to focus, cut costs, redeploy capital. I was actually lucky enough to be part of the consulting team that did the spin out from Pfizer of a company called SpringWorks a few years ago. It took deprioritized assets out of Pfizer, and that company was acquired for, I think, three or four billion dollars earlier in 2025. So we saw similar success with Cerevel. That was another Pfizer spin-out that AbbVie bought for about 9 billion. So there are some great returns, which is why more companies are looking at this kind of strategy. And then again, just earlier this year, BMS spun off some autoimmune drugs with the backing from Bain. So yeah, the macro environment has a huge impact on how companies think about deploying capital, think about investment, but it also gives them a chance to think about specific opportunities coming off the back of that as well. So hopefully that answers your question. Yes, absolutely.

Christian Soschner01:42:16

You mentioned earlier that we also have new players emerging, like private equity, which, in my opinion, have a little bit of a different mindset, like venture capital. Is this just the moment in time that we see that private equity moves towards the biopharma space, or do you think we have a lasting development that we see more and more players emerging?

Alasdair Milton01:42:37

I don’t think it’s a blip. I still don’t think that private equity is necessarily going to be investing in early stage drug development anytime soon. I think that’s still the area for VC. I think where we see a lot of our private equity clients investing is around pharma services. So pharma companies are increasingly outsourcing a lot of clinical trial work, a lot of manufacturing. And so for PE, there’s a lot of activity there about picking up different players around the clinical research and in the CDMO space. I think the Bain and Carlyle funds are a little bit different. I think Carlyle actually took private a gene therapy company called Bluebird that wasn’t doing so well. And they had some commercial challenges, and so they it was a take private. They just relaunched the company. And so they’re gonna try and I think optimize manufacturing and do different things to be more commercially successful. I think those are the outliers rather than you know where we’ll see a lot of PE investing. But I think I don’t I don’t expect PE to do traditional biopharma preclinical phase one investing. There have been those examples of the sarclesa example, where they’re definitely putting capital into drug development in return for future royalties and sales. But a lot of our the activity we see is around the pharma services ecosystem.

Christian Soschner01:44:03

Yeah, it’s good when more money is flowing into this area, it means that people can do more. So it’s always a good sign that the activity is probably coming back, and we have seen the worst in the past and looking more towards a brighter future.

Christian Soschner01:44:18

When we look at the challenges, it’s not only in locally in the US, but there’s also a global shift. China, India, new players are emerging. How do you see the world changing regional wise?

Alasdair Milton01:44:32

Yeah, do you mind if I pull up another slide or two? You’re welcome. Okay, hold on a second. Let’s talk a little bit about China and India. So to me, what we’ve got here is a slide that shows it’s a pipeline database for monoclonal antibodies. So it shows the number of monoclonal antibodies in each year of the pipeline, the global pipeline from 2015 to 2025, and it’s split between the US, China, and the rest of the world. And you can see in 2015, China only was producing around 5% of the global monoclonal pipeline. If you fast forward to today, it’s around a third. Now, are these all what we would think of as truly innovative assets? No, no, they’re not. Most of them are probably me-too, me-better. But it just goes to show how fast the Chinese have caught

Alasdair Milton01:45:30

Up. I was in China seven or eight years ago. I was doing some work with a private firm that I was at, and it was for an advocacy group, pharmaceutical advocacy group, and we were there in China and India to talk to local government and to try and persuade them to invest in innovative medicines. And we talked about the fact that it, the number of jobs it attracts, the number limit of investment, and you fast forward just seven or eight years later, and that’s the really impressive thing about China to me, it’s the speed with which they’ve caught up. So while India, I think it’s kind of stood still since I was back in 2018, it has evolved a little bit, China has just rocketed. It’s just absolutely incredible what they’ve done. And I think that’s a combination of a lot of the regulations that they brought in, a lot of local tax incentives, but also becoming more plugged into the global networks around manufacturing standards, R&D standards as well. So, one-third of the monoclonal pipeline now coming from China is absolutely incredible. If I just kind of flick forward one other slide, this is showing the deal trends between 2014 and 2024 in China. The blue bar shows the number of outlicensing deals done from China, and this is not just US companies, it’s any company outside of China. So this is all the outlicensing deals done and from China. And the light blue bar shows the dollar value of those deals. And I think in the first half of 25, there were six deal deals worth about 50 billion. And so you can see that 2025 is gonna far exceed 2024. I still think you know, people say is the US gonna lose its innovation crown. I still think that the basic foundational science here in the US is still the leader. I don’t think that’s gonna change anytime soon, but China is catching up fast because their system rewards innovations, as everyone knows, it’s a one-party system. What comes from the top is just infused through the whole ecosystem. And the competition there is so intense, it forces everyone to be very, very efficient. And the proof here is in the deals, right? Big pharma in from the west, from the US and Europe, they are shopping in China for the next big thing. So, yes, the US has bigger, deeper pockets, it has better infrastructure. But to me, the writing in some ways it’s on the wall. By the 2030s, I wouldn’t be surprised if a significant chunk of the world’s truly innovative molecules are coming from China. And they are aggressively trying to catch up with the US.

Christian Soschner01:48:16

Can you go back one slide?

Christian Soschner01:48:19

I found this quite interesting when I look at the percentages in the US that didn’t change pretty much. So we see 2015, about 50 percent ish participation of the US and to 2025, it’s pretty much the same. China just skyrockets from six percent, almost nothing basically in this space, monoclonal antibody, almost nothing, non-existent, and then 32 percent 10 years later. And the rest of the world, which I assume is pretty much Europe, is going from 40% down to 20%. This is a complete shift in the industry, completely eastward. And as I said, when you play it forwards 10 years in the future, if this continues and if they keep investing in this space, it will become more and more important.

Alasdair Milton01:49:13

Yeah, and like I say, a lot of these molecules are follow-on molecules, it’s not truly innovative. I think what the Chinese are really good at the moment is creating new modalities against existing targets. Have they identified brand new pathways and made molecules against those pathways? For the most part, I don’t I don’t think so. There might be one or two examples, but again, it’s they are determined to catch up. And if it continues this way, then if we keep chipping away at the innovation crown here in the US while simultaneously China is investing hard, then you could see, like I said, China being maybe the number one in terms of innovation in the next 10 to 15 years.

Christian Soschner01:49:59

How do you see the ecosystem in China? How is it how is it set up with public support, VC support? What makes it so special?

Alasdair Milton01:50:08

Yeah, I think so I’d come back to the government piece around this, and I think that’s China’s secret weapon, is that one party system. So they decided to go on in biotech. They created policies that made it easier to get funding, to get drugs approved faster. They created a lot of local perks around tax breaks to convince a lot of scientists who’ve been trained in the West that to come back to China and start their own companies. I think one of the real tailwinds was when they joined the International Council for Harmonization in 2017. So that’s when they basically kind of plugged into the, they plugged their regulatory system into the rest of the world. And so that was a huge signal that they were going to play by the same rules, and it suddenly made their clinical data a lot more trustworthy. And then a few years later, they applied to join, I don’t believe they’ve joined yet, but they’ve applied to join the pharmaceutical inspection cooperation scheme, it’s a little bit of a mouth rule, but that’s all about global manufacturing quality standards, and so it’s just another piece of evidence that they’re not really cutting corners, they’re really building that world-class system from the ground up, doing it very, very fast. And like you say, they have a thriving BC ecosystem as well. You know, I think when it comes to the deals, there and there are some watch outs as well in China. It all comes down to the data. There’s a lot of skepticism still at FDA about pivotal trials that are run only in China. You know, they want to see the results completely. Be replicated in other populations. And so there are risks and watch outs from China as well. But they’re thinking about this in terms of outlicensing a lot of these assets, getting their feet wet with international deals with the Western companies. And so it’s all about early partnerships, figuring out how the global markets work, what kind of operating models they need, and how do those deals fit into their longer-term strategy. And so those initial deals for the Western companies are basically for these Chinese biotechs, it’s about almost like a practice run that helps to build the experience base. So quite often they’ll hold the Chinese rights to these assets, they’ll license out the rest of the world deals. And so it’s just it’s but again, I come back to the speed and just how fast they’ve moved. It’s just absolutely incredible. And one thing that’s we’re noticing that they’ll do it’s quite smart is to kind of get around some of the geopolitical dynamics and to just speed things up a little bit, they’ll set up new calls. So they’ll might spin off some of their assets into US company, gets Western VCs to fund it. And I think that’s a smart way to get global traction as well and hopefully reduce some of that geopolitical risk.

Christian Soschner01:53:02

Yeah, I hope we I hope for the best. Well, but it means actually with all these dynamics going on in the world and also interfering with that, but when we look at China, there is a new actor on the market right now. And it makes sense for Western companies not only to look at Europe and the US, but also think more about China, what they develop, what they bring to the market, how they can in-license that. And you have experience in both regions. You’ve worked, you grew up in Europe, you worked in the United States and also work a lot with China. And you mentioned that there are some risks and watch outs for Western firms. What are these watch outs that Western firms should take care of when they think about working with Chinese companies?

Alasdair Milton01:53:50

Yeah, like I say, I think a lot of it is the is the is the data. And you know, you’ve got to ask a lot of the tough questions right from the start. And I think you’ve got to have boots on the ground. You’ve got to have people in the country who can meet with the local scientists, meet local business leaders, do really good diligence up front. And that’s why, again, we’ve got a really incredible China team here at KPMG. And so having access to those individuals who really understand the nuances of the market. Like I can have my opinion on China from an outside in perspective, but that’s nothing like having somebody who’s Chinese, who speaks the language and who knows the culture and who’s on the ground. And so that’s just that’s just absolutely essential is you have a team on the ground that can do that diligence and can help you kind of navigate the regulatory piece as well, who can help you understand the local culture, who can understand the data, which is obviously published in Chinese. So yeah, yeah, that I think that’s absolutely critical for success.

Christian Soschner01:54:54

This China has pretty much the same challenges like when we look at Europe and the United States. And aging population, rising chronic disease rates, and they’re also looking towards evolving the apartheid, as you mentioned before. We have a lot of investments in that area. How do you see precision medicine in China?

Alasdair Milton01:55:20

Yeah, that’s a great question. I think when you look at China, the first thing to really realize is the sheer scale of the population. Enormous patient groups for chronic diseases, for you know, big diseases like cancer, heart disease, Alzheimer’s. And I think that’s where those targeted therapies, those precision medicines can have a huge impact. If you think about cancer, for example, I think China’s now, I think it’s roughly one in four of all cancer cases globally. So it makes it a really perfect place to kind of develop and test a lot of biomarker-driven therapies and the companion diagnostics that go with them. And so you can find those specific patient populations that you need much more easily, I think, than you can in some other markets, just because of the sheer, the sheer scale. And so that actually has an effect on the composition of the drug pipeline as well. We didn’t talk about this earlier, but the molecules coming from China, yes, are probably me-too, me-better, but they are towards the more cutting edge of antibody drug conjugates, bispecific antibodies, cell engine therapies, and a lot of those therapies are for obviously you know, very specific, molecularly defined patient populations. And so that’s why China is such a great market, I think, in the long term for precision medicine. Now are there, of course, reimbursement challenges? Yes, that’s the same in any market, but I think that sheer the sheer size of that population really makes it a great place for testing those therapies, testing those diagnostics.

Christian Soschner01:57:08

And the speeds then that comes with that and the speed, exactly.

Alasdair Milton01:57:12

Like you said, that the speed and their ability to move fast. Yeah, there I’ve known some there was an asset that a Chinese company had produced, and it’s a mix of like an organoid and AI. So it’s I think it’s coming out of a company, and it’s I think they’re in Shenzhen, which I think is it’s in a region of China, which is basically their Silicon Valley, their tech hub. And this asset’s for diffuse gastric cancer. Like I say, it’s a combination of organoid models and AI. So if anyone’s not familiar with organoids, these are like amazing little 3D mini organs that you grow from stem cells or tumor cells, and it helps to really mimic how the human organ works. And so they optimized the drug using AI in collaboration with a Chinese AI company. But it was the speed, it was just astonishing. It went from discovery to I think it was I and D within just a couple of years. And so a couple of years incredibly fast, and now it’s in phase one studies in China. I think, I think if I’m right, the FDA just granted it earlier this year fast track status, which is a huge stamp of approval. So, again, that speed that they’re able to move at is really quite incredible.

Christian Soschner01:58:45

You imagine huge size. I always think about rare diseases. If this China has these huge cities, so I always thought China must be in real diseases really a good place to do studies when they can really pull from the entire population, homogeneous population, patients into that studies. And this is my explanation for why they can move so fast.

Christian Soschner01:59:12

When you look at China, what advancements do you see coming out of China that personally excite you?

Alasdair Milton01:59:21

I think that story is what really blew my mind. It’s again, it’s the first, as far as I’m aware, it’s the first ever drug that combines organoids and AI. And again, that speed, the FDA stamp of approval to get that fast track designation. It’s in the clinic now. Like that to me is that really kind of blew my mind a little bit, is that they had this Chinese company that had developed its first ever drug using AI and organoids, and it was now in humans within a couple of years of just the inception of the company, I think. So yeah, again, we talked earlier around a lot of the molecules that we saw in that chart where me-too, me-better, and it wasn’t truly innovative stuff, but there’s a perfect example of true innovation there. So that to me was very exciting to see. Now let’s wait and see what the clinical data looks like. Let’s wait and see what the clinical data looks like outside of China. There’s a long way to go, but again, it just speaks to the focus, the drive of the Chinese to be at the forefront of biomedical innovation.

Christian Soschner02:00:48

Yeah, it’s a huge development. You had the 90s basically, Europe and the United States. China then became the factory of the world. Then in 2015, when we look at your chart, China takes off. Now we’re in 2025, and you mentioned earlier India. When we say India is a little bit time-wise its own market, China is already there. Where do you see India play a role in the next 10 years?

Alasdair Milton02:01:16

Yeah, that’s a that’s a great question. So, like I said, I was there eight or seven or eight years ago with the advocacy group, and India’s kind of stayed still and China’s just accelerated. I think India’s role in the in the biopharma world is a little bit interesting. They’re not they’re not trying to compete head to head with the US on or on China on the breakthrough science. They’re playing a little bit of a different game, kind of focusing on what they do best. So making things affordable at huge scale and innovating in kind of different ways. So we’ve obviously seen their manufacturing muscle with vaccines and biosimilars. You know, there’s a huge reason those drugs are cheaper globally because of the Indian ecosystem. But the news story is actually they’re moving to kind of original R&D. You’re starting to see very early days, but you are starting to see some really cool stuff in oncology and cell therapy. I think it’s a sign, early stage sign, that they don’t want to just be a manufacturing hub anymore. And again, similar to China, huge population, a great place to run clinical trials. And so I think if the Indians can get more investment and the government continues to support them, India could become a pretty major source of cost-effective innovation. The challenge, though, unlike the Chinese, is that it’s not a one-party system. Yeah, I think a big part of the Chinese success story is because of the Communist Party and because they’re able to just say, we are gonna do this, and that’s it, and it happens. I think India, it’s not like that. It’s the world’s largest democracy, it’s much more fragmented. And so that the political dynamic is a little bit different there. And so that could be something that holds them back a little bit. But they’re definitely evolving as well, just not at the same the same rapid pace as the Chinese.

Christian Soschner02:03:25

Yeah, I think India is 1.2 billion something people, so it’s pretty huge and democratic system. For the patient, I’m optimistic. When we look at your chart again, and have the picture in the mind from two-continent system now with China, Asia is emerging, India, then we have basically half the world working for the patients in the future together on solving our medical challenges.

Alasdair Milton02:03:53

It’s pretty optimistic. Yeah, it is. It’s good. I think the continent that’s missing out there is obviously Africa. Yeah. So we don’t we don’t see we don’t see enough investment in Africa. I think it’s still, I mean, there’s obviously a lot of geo, there’s obviously a lot of political tensions in a lot of these countries. It’s very, very hard for companies to get any kind of decent pricing. It’s logistical challenges of moving therapy as well. So, but I’d love to see more effort and into Africa for truly innovative medicines rather than just you know vaccines and you know anti-infectives and stuff like that.

Christian Soschner02:04:35

Since you mentioned Africa, I’m also curious how is your perspective on Latin America?

Alasdair Milton02:04:40

Yeah, that’s a yeah, good question. So again, I it we say Latin America like it’s one area, right? And then you know every country there is so different. Brazil has some of the most advanced diagnostic technologies and diagnostic labs and cutting-edge labs in the world. And so I think again, you have to think about these countries in different ways. I think Brazil is further ahead than a lot of other Latin American countries, but again, there’s just a there’s just been a lack of focus on innovative pharma in these countries for a long, long time. And I do think it has to come from a lot of government stimulus, and a lot of obviously a lot of these countries in a lot of political turmoil and budgets are very very tight, and you know, we’ve had catastrophic social issues in countries like Venezuela and Argentina, and so the highest priority for government isn’t always healthcare. But I think that it that can be that is the key thing, is the government really investing and stepping in. We just haven’t seen it a lot, unfortunately. But Brazil is definitely the standout.

Christian Soschner02:05:55

I want to try to look for the optimistic lens and imagine that all these continents that we talked about working together for the patient. Just imagine what we can achieve, what leaps we can make in innovation in the pharma industry.

Alasdair Milton02:06:10

Yeah, I agree. I agree. I think unfortunately their healthcare isn’t always top of the list for a lot of these governments. Hopefully that would change.

Christian Soschner02:06:24

Yeah, we will solve that. I’m optimistic when we look at the future for the patients. You mentioned that you’re pretty optimistic about precision medicine, and you mentioned that you see it as the future of medicine. Why are you so optimistic about this area?

Alasdair Milton02:06:42

Yeah, so I think it’s probably one of the most exciting times in the space of precision medicine. Let me let me kind of back up and just give you an overview of how we think of precision medicine here at KPMG. It’s a it’s a muscle we’ve been building for a number of years. Again, coming from a PhD in cancer biology, a lot of leaders here in KPMG have written books in the space. We’ve we’re known internationally, giving talks at leading conferences. And so it’s something that we our team has built a special capability in as a real double-click area. And we don’t just think of precision medicine as say EGFR testing and lung cancer. I think of precision medicine as how can I take data, right? How can I take data about Christian or take data about Alasdair and tailor an intervention to you as an individual based on that data? Now that data could be genomic, it could be proteomic, it could be metabolomic, it could be something to do with your lifestyle, it could be something to do with your diet, it could be something to do with your environment. But that to me is our how we think of precision medicine is how can we take data to tailor an intervention to an individual based on something that is unique to them. And to me, it’s the most exciting time to be in this space. Yes, oncology is the vanguard of precision medicine. We’ve been in precision medicine and oncology for decades. We actually still don’t get it right, we still don’t get the drugs to the patients like we should. But think about the new tests that are coming through in neuroscience around Alzheimer’s. That there was a first ever FDA-approved blood test to diagnose Alzheimer’s approved this year. It’s for adults aged 55 and over who are showing some cognitive impairment. You know, it’s a huge deal. We can move away from relying, hopefully, on costly and invasive PEC scans. It starts to change the narrative about diseases like Alzheimer’s from being based on the symptoms to actually being based on the biology. And it’s not just Alzheimer’s, okay? It’s advances in genomics have been incredible in diseases like Parkinson’s and epilepsy. We used to just think of them as Parkinson’s or epilepsy, we used to lump them together into broad categories. And now we know there’s specific genetic mutations for various forms of epilepsy. You know, that allows us to classify that disease by its genetic and its molecular

Alasdair Milton02:09:22

Mechanisms and not just by the clinical. And then another area that we’re seeing a lot of focus in is women’s health. That’s seeing a major structural shift. Diagnostics is really the foundation of it all. We’re seeing a lot of innovation and funding pouring into women’s health. You know, the labs are becoming faster, more personalized care. We’re seeing innovators making really big strides in areas like menopause, fertility solutions. And then overall, I think we’re in a we’re basically in a post-genomics era in precision medicine. So it’s now about proteomics, it’s about single-cell analysis, it’s around spatial biology, and we’re seeing a lot of deal activity around that as well. So Thermal bought a company called O-Link last year for about $3 billion to get their hands on the proteomic capabilities of Olink, Illumina acquired SomaLogic earlier this year for something similar. So, this to me is not just cancer testing anymore. It’s about how do we understand the drivers of disease and tailor therapies to individuals, and we’re now looking beyond oncology, into immunology, obviously rare disease, neuroscience, cardiovascular as well. So areas that never sought any investment, we’re now seeing a lot more focus. So I’m, you can tell my I put my scientific hat on, I get super excited about this space, but I think it’s a game changer because if we can

Alasdair Milton02:10:55

If we can really harness the power precision medicine, we can ensure better outcomes for patients and lower cost to the healthcare system.

Christian Soschner02:11:06

It seems to spread in every area. It’s really really a complete shift in a paradigm shift at the end of the day. It’s not just disease focused anymore like it was in the past. It’s now, as you mentioned, we’re looking more towards understanding the disease in the first place and preventing it. It’s a complete game changer in the NDI industry that’s coming. Can we say that can we set it this way?

Alasdair Milton02:11:32

Yeah, I think so. There’s still systemic challenges. So I think, especially in the US, the system no healthcare system was designed for precision medicine. The healthcare systems were designed by and large to produce pills and tablets and sell them to the masses to for huge chronic populations. And so the delivery, the discovery, the manufacturing, the delivery of precision medicines, the partnerships that have to happen between pharma companies and diagnostic companies, the labs where the tests are run, the obviously the emergence of AI and you know, precision medicine generates just such a huge amount of information on individuals. So having that technology of AI been able to interpret that data. But the system wasn’t set up to deliver precision medicines. And so unfortunately, a lot of people don’t get the therapies that they should. But you know, hopefully over the next five to ten years we can start to close some of those gaps.

Christian Soschner02:12:31

But this also means what you say that we have to remodel the entire healthcare system in the countries when it’s not set up that way. That’s a huge opportunity also to for many other industries when we see such a paradigm shift. Leads me to the next question. If you could redesign one part of the healthcare system to fit for precision medicine, what where would you start?

Alasdair Milton02:12:59

I think I’ll talk about the US first because that’s obviously my home market. I think it would have to be about the data. I talked about the data being the fuel for precision medicine, and I think we need to do a better job of standardizing it, improving the quality, and actually sharing it. So the healthcare system here is so fragmented. So trying to share patient information between different places is a real problem. It makes it hard to follow somebody along the should only through the system. And on top of that, everyone’s using their own systems. There’s no common way to talk about the data. And to be quite honest, the core Quality of the data between institutions can be very different. We are seeing some new systems being developed which allow the system to talk to one another. So there’s the system called Epic Care Everywhere, which is a health information exchange platform that basically allows healthcare practitioners that use Epic’s electronic health record to securely share patient information. But so we’re starting to see new systems like that. But I think that would be for me the key thing about the US market is how do we share that data and standardize it and make it of a higher quality. And then if I take a step back and think about countries outside the US, I think there’s just a huge job to do around precision medicine. I kind of alluded to this about patients not getting the right therapies. We need to teach physicians and all healthcare practitioners and all healthcare workers more generally who support the ecosystem about precision medicine and what it can actually do and how to use it effectively. So that those would be the things I would try and change with the system. A lofty goal, but hopefully one that we can achieve one day.

Christian Soschner02:15:01

So Vanilla Studio Rights data is becoming more and more important as the basic layer of precision medicine.

Alasdair Milton02:15:08

Yeah, yeah, exactly. And there’s a huge amount of it. It could be, like I say, it could be genomic information. I know I talked about the post-genomic era where we’re starting to think about what’s interplay with proteomics, with metabolomics, transcriptomics, that whole omic system, the biology part, but also your environment, right? Your environment plays that plays a role or your lifestyle, what you eat. It’s all about that data. So that’s the fuel for precision medicine. Then you overlay the AI on top of that to interpret that data and hopefully guide the right treatment decision for the patient.

Christian Soschner02:15:45

To pick up as well that you mentioned artificial intelligence, what role does he play is heat playing in precision medicine?

Alasdair Milton02:15:52

Yeah, let me, I’m gonna go back and bring up another slide here. Just to give you some examples of how we’re seeing AI in precision medicine. Can you see that okay? Yeah, perfect. So that this actually shows what we think of as the precision medicine continuum. So it goes from risk assessment on the left all the way through diagnosis and treatment and then and onto monitoring as well. And what I’ve done here is just highlight you know one example of how AI is helping across the entire continuum. So we’re using AI on mammograms to predict the risk of a risk of breast cancer. I worked on a deal in this space a few years ago where the client was looking to make an acquisition of a target, they had an AI algorithm for just this kind of use case. And the client’s technology could take hundreds of thousands of mammogram images and look at various parameters such as tissue density and predict if a woman was at risk of developing a tumor, even before the tumor was there, which is pretty incredible. If we think of it screening, if we move over to the next part of the and the next chevron, finding a disease amongst otherwise you know very healthy individuals, that’s really the holy grail. You have to balance the sensitivity and the specificity, which is critical. So the chance of false positive or false negative. There’s companies like DELFI is one company. They’re developing algorithms to detect liver cancer and blood tests from people who are otherwise healthy. Then we think about the diagnosis or the confirmation of disease. There’s companies developing AI algorithms to confirm diagnosis. We’re seeing a lot of the use of the technology as being complementary to digital pathology. So you can create digital versions of pathologist slides and then overlay an AI algorithm that’s got much better accuracy than a human identifying cancer. And then from the prognosis piece, AI has been used to ensure that some cancer patients, like prostate patients, they only receive hormonal therapy when they’re actually going to need it, right? Because hormonal therapy has a lot of significant side effects for men. And so why give that hormone therapy if you don’t actually have to? On the therapy selection piece, this is really where precision medicine targeted therapies, companion diagnostics is most mature. But we don’t have great separation between targeted agents and immunotherapies, for example. And so we can use AI to leverage multiple markers, look at PDL1 staining in addition to something like CD8 positivity to really try and predict response. And then on finally on the monitoring piece, looking at recurrence as well. So, similar to screening applications, making sure you’re accounting for the sensitivity and the specificity levels,

Alasdair Milton02:18:48

But companies are using AI to better monitor for recurrence through what we call MRD, minimal residual disease in a lot of blood cancers. So exciting times in the space. And this is not including the role of AI in designing new molecules, smarter molecules in the R&D process, helping us think through how we match the right patient to the right clinical trial based on the different genetic markers the patient might have. So we’re optimizing the clinical trials. Then there’s the role of AI in writing physician notes. It’s really impacting a lot of the entire, it’s impacting the entire precision medicine ecosystem, to be quite honest.

Christian Soschner02:19:36

As I said, amazing times when we then add to come to the next part, the vision for biopharma in the future. When you also imagine all these gadgets that we have these days that take data, like smartwatches, smartphones, earphones, glasses, that now companies work to put artificial intelligence in glasses and you can then track the eye movements. This must be heaven for diagnostics and also for track development, especially cell machine therapy. Do you see this really coming that we can bring over time this all together in future?

Alasdair Milton02:20:13

I mean the optimist in me says yes. I think we have to, we have to be, right? That’s what we’re all aiming for. But the there are just systemic challenges around delivering care. Let me let me go back up one and I’ll pull up one last slide, which I think it’s hopefully you know kind of lays bare the challenges that we face, unfortunately. So this is a slide that it shows there’s published data here, you can see that the reference at the bottom of the slide there. And it was published a few years ago. And what it basically says is for advanced non-small cell lung cancer patients, if you took a thousand of them who should get a targeted therapy, right? That thousand on the far left, how many actually get that therapy? And it’s only around a third. Now, bearing in mind that we’ve been doing precision medicine in lung cancer for decades, over two decades, and we’re still not getting it right. Okay, so we see drop-offs of patients because perhaps the right test wasn’t ordered. So maybe the physician orders a PCR test when they should order an NGS test. There’s maybe a drop-off because the pathology report comes back and it’s not interpretable by the physician. There could be a drop-off because there wasn’t enough tissue taken. So there’s all these different reasons. If we go through these, these multiple steps here, where by this analysis, anyway, only a third of advanced non-small cell lung cancer patients who should get a targeted therapy actually get one. Now, again, this dynamic is probably not happening to the same extent in large academic medical centers like the FARBAR, like MSK, like City of Hope, but it still happens. The challenge is that in this country at least, 80% of oncology patients are not treated in large academic medical centers. They’re treated in the community where they’re seeing an oncologist, two ABCs, two head and neck, four breasts, three long every day. And so they’re just trying to get through their day and testing in the right way. It’s just it’s just very hard. And this is where this incredible world of genomic science bumps up against the realities of everyday clinical practice. And so, for those physicians who are in the clinic, they just need to know for this patient with these symptoms, what test do I order and what do I do with the result? Right? What’s the translation of that result? If they have a report that comes back and says variants of unknown significance, what does that mean for them? And so that’s the challenge. And so while I get so excited about all of the science, all the things we’ve talked about, all the opportunities, cell and gene therapy, targeted therapies, AI, we’re in a post-genomic era, all this incredible data we’re collecting, the fundamental challenges of a system that is designed for delivering pills and tablets and was designed 20, 30 years ago, now bumping up against the reality of that science. This is unfortunately what we see. So a little bit sobering. But always hopeful. Always hopeful that we can solve these challenges.

Christian Soschner02:23:53

So we have great visions, great possibilities, but work through the reality that we have right now and solve one problem after the other to get there at the end of the day. So when I imagine that you have the power to set and to focus the entire industry, very big biopharma and also the healthcare systems, everything you talked about. And you have the power to set one core goal for the next decade to make a leap towards solving all these problems. Yeah. What would this core goal be?

Alasdair Milton02:24:33

Can I can I just one? Let me let me give you I’ll give you a short answer and I’ll give you two answers. No, the first one’s really short, the second one is probably a little bit more lofty. I think I would love to see more biopharma companies externalize a lot of the great science that gets killed every quarter in the R&D portfolio discussions. There’s a lot of great science that goes on the four walls on these pharma companies, and it never sees the light of day. And we’re seeing more companies externalize these deprioritized assets. There was an example earlier this year of BMS doing a deal with Bain Capital. So again, PE company, externalized a lot of that science. So that would be my one thing I’d love to see in the short term. But I think that for the longer term, the more aspirational, I actually think not just biopharma, but I think it’s time for the life sciences industry to move away from being an industry that’s more reactive to one that’s been more proactive. So we’ve been a sickness industry, right? We’ve treated disease, chronic disease, but can we move more towards lifelong wellness and kind of preemptive health? So instead of selling drugs to treat conditions once they appear, I think we need to be working harder as an ecosystem to predict disease risk years out and developing interventions that help to reverse things like cell damage before it becomes a diagnosed illness. And I think that puts the patient at the center of things. I think the industry overall and life sciences overall, we talk a really good game about patient centricity, but an approach that’s actually focused on wellness, it that’s inherently just more personal. You know, it requires a continuous understanding of someone’s biology, their lifestyle, their environment. You’d have to create platforms that people can engage with throughout their lives, provide personalized guidance and interventions, rather than just interacting them, interacting with them when they’re sick. And to be honest, I think we need this approach. We all know that healthcare systems around the world are really buckling under the pressure of aging populations with chronic diseases like diabetes and Alzheimer’s. And I understand it’s a huge ask of the industry, but and it doesn’t move fast. I understand that our biopharma companies, our life science companies, for the most part, are for profit and they need to make their quarterly numbers. But I think it would take some really bold C-suite executives to make this happen. But I also think we could we could actually change some of this through the incentive structures. So whether it’s you know government or private insurance, we start rewarding outcomes and not procedures. So maybe we give higher reimbursement rates for proactive screenings or wellness consultations. But I think that would be for me the thing I would try and change about the industry over the next the no the next decade. I think that the current business model, I’m not sure, is entirely sustainable.

Christian Soschner02:27:50

Yeah, credit, yes, credit yes. And I think for the first time in human history, we have also the tools and the means to do that. We don’t think the past was probably more restrictive in the available tools now with AI, with all these capturing tools, data capturing tools. You mentioned a really interesting point. Maybe we dive a little bit deeper into that, incentivize the big companies to externalize their data at the end of the day. It sounded to me you were talking about especially data

Christian Soschner02:28:21

Of trials that failed, or when companies make a strategic decision and say we don’t move forward into that direction. So they just grab the whole part and drop it and say no, we don’t need it anymore. And there is no incentive for us to publish the data or give it away because it for us it’s it does not have any value. Did you understand you writing that part? Did you mean this part of this data?

Alasdair Milton02:28:44

Yeah, no, it’s sure it’s the data, but it’s the data tied to the asset. So what I mean is that you know every quarter, every pharma company goes through a portfolio exercise where they say what are we going to fund and what we’re not gonna fund.

Christian Soschner02:28:56

Yeah, yeah.

Alasdair Milton02:28:57

And the drugs that don’t get funded, they go on the shelf. And that IP expires and the drug is not commercially viable. Now, sometimes they’ll try and externalize it, sometimes they’ll give it to patient groups, but there’s not a systematic way to collect all of the incredible science and incredible assets that go on the shelf every quarter from the industry and figure out how to fund them and get them out of big pharma and new vehicles where we can get those assets to patients. So I worked on a project in 2017 with a prior firm where we took deprioritized assets from Pfizer and we spun it out to a company called SpringWorks. And SpringWorks was subsequently sold to Merck KGaA, so German Merck, earlier this year for about $4 billion. And Pfizer had some upside there. And similarly, Pfizer did something very similar not long after the SpringWorks deal. They took neurological assets that they deprioritize and spun it into a company called Cerevel. And now BMS has just done it with some, I believe it was immunological assets in that partnership with Bain. And so companies are thinking about it a little bit more, but we’re seeing it sporadically. I’d like to see a systematic approach to that where pharma companies can come together and pull those assets and then figure out how we get funding for them because patient groups have some money, there’s other types of capital that can be deployed, PE money. So I think that would be to me a great thing to do because there’s just and just I just know there’s great science that never sees the light of day because it’s killed in a quarterly portfolio review.

Christian Soschner02:30:45

To me, it sounds always when I listen to you that big companies don’t have any incentives to do that. Do you have any ideas how we can incentivize that so that they have more drive to go in this direction?

Alasdair Milton02:31:00

Yeah, it’s a good question. I think what I would say is when I look at the stories of both SpringWorks and Cerevel, that should be an incentive for pharma. I mean Cerevel sold to AbbVie, I think, for about $9 billion. Wow. And SpringWorks sold for $4 billion. So it shows that if you put the effort in and you spin these things out and you stand them up properly, you can share in the future upside. So and that to me is, I mean, pharma right now is grappling with the challenges of how do we free up capital to reinvest in the pipeline? How can we get creative with, they’re talking about controlling their cost structures, but how do we then like realize value from the existing pipeline? Maybe it’s not in our hands, but if you were to externalize it, then you’re you can get that revenue stream further down, you can redeploy that into the pipeline. So I think that would be that’d be I think those two examples are great examples of how that model can work.

Christian Soschner02:32:04

So we need to spread success stories more that people see how that works, and that at the end of the day it positively influences availability of capital for new strategies, but also market capitalization.

Alasdair Milton02:32:17

Yep, exactly. But also I think and supporting the ecosystem, obviously, but also I think a lot of patient groups are very vocal, especially in areas like rare disease, and they do not like it when drugs are terminated and the whole area just goes away. And so they’re very vocal. And so there’s I think there’s a there’s a public relations angle to this as well, where the industry can seen can be seen to be doing better for patients as well.

Christian Soschner02:32:45

Yeah, totally agree, totally agree. You have a long career, a very interesting career, from Scotland to the United States, from Labbench to KPMG advising big companies. And I can imagine that when someone younger from the younger generation is listening now to this episode, that they want to move not only into life science and biopharma, but also say, I would like to also understand the business aspect myself. What advice would you give to the younger generation now in their early 20s? How should they approach this?

Alasdair Milton02:33:27

So I think you have to be someone who can be a good translator. And by that I mean, can you explain complex science to a business leader in terms of market opportunity, right? We talked about this before, or it to an investor in terms of risk and return. You have to be able to build the bridge between the lab and the business world, and that’s an invaluable skill. I said before that scientists they tend to get knee deep in the detail, and that’s great, but you have to be able to bring up a level to something that’s understandable to business executives. So I’d spend time learning about the industry. You don’t have to do another degree, listen to podcasts like this, read books, take online courses, connect with people in the industry. I’m always happy to connect with people and share my experience and my perspectives, try and you know, carve out time with them to learn, learn about the industry, learn about regulatory affairs, R&D, and commercialization. It’s not an easy road, but if you’ve got the drive and if you’ve got the focus and you’ve got the energy, then you’ll make it happen. But yeah, that would that would be my advice. Is and also I think sometimes I’ve heard I didn’t have this myself, but I’ve heard other folks who’ve been very successful in their careers. They had mentors from outside of their own industries. So they had people, maybe they were they were a scientist themselves, but they maybe had a mentor who was from the finance world who could impart their own advice as well. And so if you can find that mentor to help support you, I think that can be that can be a very, very powerful kind of you know guiding hand for you.

Christian Soschner02:35:08

Yeah, totally agree. And when we look at your team, how do you see your team impacting the industry and society in the coming 10 years? What goals do you pursue?

Alasdair Milton02:35:19

What goals are we pursuing? That’s a good question. You know, I think I’ve been so lucky in my career to work on some just incredibly impactful projects. The example I gave earlier of Spring Works, been able To take those deprioritized assets out and get them to patients. I’m lucky enough here at KPMG to work on just really exciting cutting-edge projects from really helping those smallest biotechs with their equity stories to helping the biggest bio farmers with their precision medicine strategies or working with some of the most exciting diagnostic companies. And so at the end of my career, I’d love to look back and say the work that we did here at KPMG, it really moved the needle. And I come back to this idea of prevention, it moved the needle on how we move healthcare and disease from treatment to prevention. So how can we identify patients earlier who are at risk of developing disease? How can we intervene to make sure they have optimal outcomes? How can we continue to monitor them on their healthcare journey? And I think that’s what our team is focused on is supporting our clients who have that goal. And I just I’m just incredibly grateful and lucky to have that opportunity.

Christian Soschner02:36:49

Yeah, absolutely. There’s a lot of work that needs to be done to get society then at the end of the day to the great vision that you outlined. Elste, we have a great conversation. I really love it. Every single second. Before we wrap it up, are there topics open that you would like to discuss? It’s the final part.

Alasdair Milton02:37:08

I would just I maybe want to just cover some of the key conferences. I know the audience here is very much focused on the biopharma space and the early investors. And so I’d I just I’d just have folks think about attending some of the key conferences like JP Morgan, like bio, where they can really get a chance to speak to like-minded investors. You’re gonna have an unparalleled chance to you know network. It’s really a lot of these conferences are the epicenter of kind of deal making and investment. You’re gonna get great opportunities to you know, speak with industry leaders. So I think that would be one thing we kind of didn’t talk on. That’s those are conferences that we attend regularly. I think if there’s one thing I’d want people to take away from today, though, it’s you know, engage more with your health. And we didn’t talk too much about this. What with KPMG did a documentary last year on precision medicine. We talked about some of the leakage gaps on the slide that I showed, and we brought in different stakeholders from across the ecosystem, like pathologists, oncologists, industry, patients, to give their perspectives on the ecosystem and why we saw those gaps and how we have to work together. And what came out of it for me was that people don’t engage with their health enough and their healthcare enough. And so if you’ve missed your annual screening, go and get it done. And so that would be one thing I’d want to just cover with folks is you know, be more engaged with your healthcare. And if we can if we can do a better job of treating upfront and preventing disease, then it’s gonna be better for the individual and for society.

Christian Soschner02:38:57

Yeah, absolutely. I mean taking more care of health makes absolute sense. Yeah, it’s been a pleasure, Christian.

Alasdair Milton02:39:05

Thank you so much.

Christian Soschner02:39:06

Alasdair, thank you very much for this great conversation. I laughed every minute. My final question to you is how can listeners best reach out to you?

Alasdair Milton02:39:16

Yeah, I had my email up on some of those slides. If folks didn’t manage to note that down, then happy to share my email address. Also I’m on LinkedIn. Those would be the two best ways to contact me.

Christian Soschner02:39:31

So if you are fine with it, also put it in the description, your LinkedIn profile, email address so that people can directly connect with you when they are interested. Alasdair, thank you very much for this great conversation. Loved every single minute of it. It’s really brilliant. Let’s stay connected, let’s stay in touch and catch up soon.

Alasdair Milton02:39:47

Definitely. Thanks, Christian.

Christian Soschner02:39:49

Have a great day. See you. Bye-bye.

Alasdair Milton02:39:51

You too. Bye.

Christian Soschner02:39:53

This conversation landed on something bigger than biopharma. It showed how extraordinary science can exist and still fail patients if systems, incentives and execution don’t evolve with it. Precision medicine is no longer a scientific question. It is a leadership question, a capital allocation question, and a systems design question. From China’s speed advantage to artificial intelligence across the full precision medicine continuum to the uncomfortable truth that only a fraction of patients receive therapies that already exist, the message is clear. The next decade will reward those who understand translation and not just innovation. The next episode goes deeper into how leaders navigate complexity when science, markets and geopolitics collide. Until then, stay curious, stay disciplined, and stay engaged with the ideas that actually move outcomes.