Do you believe that the quality adjusted life year [QALY] calculus used by the UK National Institute for Health and Care Excellence
[NICE] adequately measures the contributions of a biologic drug for a limited rare disease population versus a small molecule
drug for a chronic condition designed for a much larger population?
Ornskov: QALY calculations form only part of what is a clinical guidance that also covers other means for establishing whether a drug
is cost effective or not. This is a complex decision-making process, as NICE officials have acknowledged many times. That
said, I don't think it is helpful to set arbitrary frameworks that conclude if a cost per QALY is over a certain amount, then
the drug won't be made available through the NHS. A QALY should never stand alone. By itself it certainly doesn't serve as
an adequate measure of value in rare diseases.
Many companies today are positioning themselves not as pill manufacturers but as "total health solutions" providers, with
a heavy services and outcomes delivery component. Is this part of the Shire strategy?
Ornskov: Shire, for now, is going to stay focused on developing innovative medicines that address unmet medical needs. This is our
competitive advantage. We have a decade-long track record in delivering strong growth and returns to shareholders. A singular
commitment to developing and marketing innovative drugs is the best way to continue that performance. Anything else would
What plans do you have for the Shire sales force? Are there changes underway in how you intend to introduce and sell Shire
Ornskov: The sales function is facing significant changes as information technologies create new ways to interact with healthcare
professionals. Overall, the climate has become more hostile to the traditional methods in which companies communicate to this
group. At Shire, the sales force will remain central to our marketing and information strategies. What we are paying more
attention to is the quality of our relationships: Do we have the best educated sales reps? Is there a better balance we can
strike between a purely promotional message and more medically aligned and driven opportunities that further enrich these
contacts? How can we supplement direct personal contact with the other channels that technology now offers us?
What matters most to me is keeping our eye on the feedback loop we get from prescribing physicians. We must ensure that their
exposure to Shire reps is of sufficient quality and meaning to them that they will willingly allocate the time to see us.
This feedback is going to be reflected in our compensation system as well as the scale and scope of our investments in the
Shire sales force going forward. And feedback is not something limited to our people in sales. Instead, receiving feedback
is a cultural imperative for the entire organization. It's the only way to remain attuned to the marketplace. If we aren't
rated by our customers as ethical, compliant, and a consistent provider of high service, then this new strategy we have in
place will not succeed.
As a newcomer to the c-suite, what differentiates the role of CEO from that of a line manager?
Ornskov: As CEO, I must relate to a much wider circle of constituencies. For example, I have multiple outside investors that represent
pension funds and depend on our returns to keep their plans healthy and solvent. There is also the responsibility you have
to patients, customers, payers and regulators. A successful CEO must be outward looking. He or she must balance these multiple
external interests with actions that drive things forward from the inside.