Biotech’s Missed Opportunity: Small-Town and Rural America

4/18/11Follow @xconomy

The biotech and pharmaceutical industry is full of people who went to the top universities, live in the fanciest neighborhoods, and work for brand-name companies. But this industry needs to start thinking more about millions of people who are mostly an afterthought today. I’m talking about people who live in America’s small cities and rural areas.

This isn’t something I’ve personally thought about very much, since I spend most of my time zipping between the toniest ZIP codes in the U.S., where most healthcare innovation occurs. But the idea dawned on me this past week after I traveled to a place just 270 miles from home, yet a world away—Spokane, WA (population 208,000). It became even clearer over the next couple days during a trip to one of the top biotech clusters—San Francisco.

The way things work today, people in the top biotech clusters don’t talk to folks from small cities and rural America. Companies developing new drugs, devices and diagnostics tend to congregate in a few hubs like San Francisco, Boston, and San Diego. Folks in these places cultivate relationships with “thought leaders” at major urban medical centers like Massachusetts General Hospital in Boston, UC San Francisco, or Memorial Sloan-Kettering Cancer Center in New York. The companies hope that these thought leaders will run a stellar clinical trial of a new drug, tout the result at medical meetings, and influence peers to prescribe it once it reaches the market. Patients with money and good health insurance are often the ones fortunate enough to see these doctors, and get access to treatments that offer new hope.

It doesn’t have to always work this way. Having so many trials routed through the major urban medical centers is expensive. It also taxes the time and attention a given “thought leader” can provide to the testing of any one product. And it puts drugmakers in a fierce competition with one another for a finite number of patients who can enroll in a study, of, say, a new lung cancer treatment. When drug companies think about alternatives to those bottlenecks, such as ways to speed up clinical trial enrollment and save money, they often think first about going to China, India or Eastern Europe—not places closer to home like Spokane.

But guess what? There are good reasons for biotech and pharma companies to take a closer look at lower-cost “second cities” in the U.S. The doctors who live and work there, and who often serve rural communities, may not get their names in the New England Journal of Medicine like the big guys. But the small city doctors often did get their training at top-notch medical schools, and know what they are doing. Many of them have long-term, trusting relationships built up with their patients, who have long-term roots in their communities. These doctors regularly see patients who struggle with the major epidemics on the radar of Big Pharma—conditions like diabetes, obesity, cardiovascular disease, cancer, autoimmunity, and neurological disorders.

It stands to reason that U.S. doctors off the beaten track are both willing and able to conduct good clinical trials. And if they are included in clinical trials early on, the odds are high they will champion new treatment strategies pushed by the drugmakers.

Still, I rarely if ever hear biotech leaders talk about engagement with small towns and rural areas. So I checked around to see if maybe there’s some level of engagement in small cities and rural areas that I’m not aware of. I asked Maureen Cronin, the senior vice president of R&D at Cambridge, MA-based Foundation Medicine, about the extent of engagement between drug companies and small cities. She knows something about this question, having spent nine years previously at Redwood City, CA-based Genomic Health (NASDAQ: GHDX) where part of job involved outreach to marginalized communities in the U.S., including Spokane, WA, Eureka, CA, and rural areas near Kansas City.

Cronin, who got her doctorate from UC San Diego, described her small town outreach efforts as an eye-opening experience.

“The doctors there are savvy, up-to-date on information about genomics, the latest tools, and targeted therapy,” Cronin says. “The problem is that mostly they are struggling to get access to basic resources.”

For example, Cronin says she has gotten to know three bright young oncologists in Humboldt County, in far northern California, who trained at … Next Page »

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  • Susan Severance

    What a thought-provoking piece! You have put small cities & rural america in the clinical research spotlight – if even for a moment. Great work!

  • Tom

    This is news? I’ve been in the industry 20+ years and was doing trials in the Northern Rockies, Deep South, and places in between back then. Today those places are taking a backseat to Eastern Europe and South/Central America due to volume, not quality of investigators. I’ll give you that I was not the rule back then but places like Spokane, WA & Missoula, MT both have had savvy clinical research establishments in place for quite some time. What about taking it a big step further?: what about pharma and biotech leaving the big cities and settling HQ in ‘second cities’? KC, Des Moines, Omaha, OKC could all support such operations. There are only so many Mass Generals, Fred Hutchs and MD Andersons in the world. You have to travel to them from someplace. It may as well be from a place where your company and its employees can thrive.

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  • http://none steven spalding

    R & D at all phases and levels is being undertaken at universities, research parks and bio-incubators in second tier and smaller cities. These organizations will provide value added expertise and commitment to medical research but frequently struggle to attract venture financing and management talent needed to move drugs and devices from the bench to the market place.
    Steven Spalding
    Point A Consulting

  • http://www.prnofkansas.com Kim Talbot

    Conducting trials should not be undertaken by physicians without proper training and support. This industry is one of the most highly regulated and it should be; we are talking patient safety. However, there is no reason why smaller physician groups can’t be investigators on trials if they partner with companies like ours that provides trainging, experience and support staff.

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