EP 168 - Alasdair Milton: The Innovation Inflection Point: Why 70% of Cures Never Reach Patients

Breakthrough science has never been stronger — yet patients still miss life-saving therapies.

Despite decades of innovation, most precision medicines fail at the last mile of healthcare delivery.

The problem isn’t discovery. It’s how science, capital, and systems are aligned — or not.

Possessing elite science is no longer enough to win in the multi-trillion-dollar biopharma ecosystem.

As innovation shifts from West to East and from treatment to prevention, leadership teams struggle to bridge scientific depth with incentives, execution, and real-world delivery. Capital follows speed and scale — not intention — and healthcare systems built decades ago are failing to keep up.

In this episode, Alasdair Milton, Principal at KPMG, explains where innovation actually breaks — and what must change for cures to reach patients at scale. From diagnostics and data silos to capital allocation and prevention models, this conversation reframes the next decade of precision medicine.

💡 What You’ll Learn in This Episode

1️⃣ Why only a fraction of eligible patients receive precision therapies
2️⃣ How delivery systems — not science — kill innovation outcomes
3️⃣ Why prevention is the next major value shift in healthcare
4️⃣ How capital allocation decisions quietly determine patient access
5️⃣ What leaders must change now to compete in the next biopharma cycle

👤 About Alasdair Milton

Alasdair Milton is a Principal at KPMG advising global biopharma leaders on strategy, transactions, and innovation models. With a PhD in cancer biology and two decades at the intersection of science and capital, he works with executives navigating precision medicine, prevention, and large-scale healthcare transformation.

💬 Quotes That Reframe the Debate

(01:00:20) “Great science only creates value when translated into clear commercial decisions.”
(01:37:24) “Power has swung decisively to pharma, with biotechs now starved for capital and leverage.”
(01:36:10) “Markets shift fast, but leverage always follows capital, data, and disciplined execution.”
(02:26:30) “Life sciences must move from treating sickness to predicting risk and sustaining lifelong wellness.”
(01:46:24) “China is catching up fast, and by the 2030s, truly innovative molecules may originate there.”

🧭 Timestamps

(00:04:04) Shifting from treating disease to preventing it
(00:05:32) Turbulent markets, steady scientific progress
(00:07:03) In-vivo CAR-T and the next leap in cellular medicine
(00:11:00) From chronic disease management to functional cures
(00:20:20) Bridging specialized science with corporate strategy
(00:21:55) Translating lab precision into business language
(00:22:07) Bridging scientific depth to business acumen
(00:57:40) Turning complex science into decisive commercial implications
(01:08:46) Why in-person collaboration still drives leadership and learning
(01:11:48) Navigating the $200B biopharma patent cliff through M&A
(01:17:25) Capital concentrates on de-risked teams with proven leadership
(01:18:17) Interpreting the biotech market recovery and tailwinds
(01:28:26) Long-term capital returns as pharma reclaims deal leverage
(01:38:03) Navigating IRA impacts and macro headwinds
(01:43:39) China’s rapid ascent in the global monoclonal pipeline
(01:46:24) China accelerates the eastward shift in global innovation
(02:07:31) Precision medicine redefines individualized healthcare outcomes
(02:09:03) Standardi

Transcript

00:00:00:00 - 00:00:32:16

Christian Soschner

There is the thing. The biggest failure in modern healthcare systems is not science. It is delivery. Breakthroughs accelerate, capital tightens, and patients still miss therapies designed to save them. Innovation is moving faster than healthcare systems built decades ago. Capital usually follows speed, scale and execution, not intention.

00:00:32:21 - 00:00:38:16

Christian Soschner

And even when the shifts too often, it never reaches the patient.

00:00:38:16 - 00:00:46:02

Alasdair Milton

we've been doing precision medicine and long lung cancer for decades, over two decades, and we're still not getting it right.

00:00:46:02 - 00:01:04:20

Christian Soschner

This is not a technology gap. It's a structural one. Great science gets shelved in quarterly portfolio refills. Data stays locked inside corporate walls. And an industry designed to treat sickness. Strangles to prevent disease.

00:01:04:20 - 00:01:16:15

Alasdair Milton

instead of selling drugs to treat conditions once they appear, we I think we need to be working harder as an ecosystem to predict disease risk years out

00:01:16:17 - 00:01:36:01

Christian Soschner

Today's guest, Alistair Milton, has spent two decades where science, capital and execution collide. From a PhD in cancer biology to advising global biopharma leaders, he sees clearly where innovation breaks and where it still compounds.

00:01:36:01 - 00:01:42:04

Alasdair Milton

know there's great science that never sees the light of day because it's killed in a quarterly portfolio review.

00:01:42:04 - 00:01:56:20

Christian Soschner

This conversation is about incentives, about leadership, about moving health care from reaction to lifelong wellness. For anyone shaping capital policy or strategy in life sciences.

00:01:56:21 - 00:02:00:05

Christian Soschner

This episode reframes the next decade.

00:02:00:05 - 00:02:20:12

Christian Soschner

Lester. It's fantastic to have it live. We spent some time in preparing this recording and we have a lot of great stuff to talk to, and you will bring the audience right into the center of life science out of Scotland to the United States, into the heart of our industry.

00:02:20:14 - 00:02:46:00

Christian Soschner

And I know from firsthand experience that many people these days, especially in the United States, are extremely busy. And when they jump on social media, they have five minutes. And let's assume we have part of the audience that wants to go offline in five minutes. Can you tell them what they will miss and, will not hear when they don't come back tomorrow to listen to the full recording?

00:02:46:02 - 00:02:46:09

Alasdair Milton

Yeah.

00:02:46:09 - 00:03:13:05

Alasdair Milton

So first of all, just huge thanks to yourself for for inviting me on the podcast. This, the privilege. Looking forward to the conversation. So if they if they jump off after five minutes, they're going to they're going to miss a lot around, the, the deal environment. What we're seeing in terms of the deals that big pharma are doing, that, small biotech in this situation here in the US, but also in Europe.

00:03:13:07 - 00:03:39:03

Alasdair Milton

Also about, China and its rise from being an generics driven market to in just the last few years, being a source of of major licensing deals for all our big pharma clients and also precision medicine. And those three things, they they sound a little bit, unique and interconnected, but, they definitely are. And, you know, if folks, jump off after five minutes, they're going to miss that interconnectivity.

00:03:39:05 - 00:04:04:16

Alasdair Milton

I would say that overall, I think my take right now is that despite the turmoil and turmoil in the market, the science keeps evolving, the science keeps marching forward. And I think that we overall, we have to move away from this is one of the key themes of this. This conversation is we've got to move away from, treating disease to preventing disease.

00:04:04:21 - 00:04:19:06

Christian Soschner

That's a good point, to 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 minds the most in this year? Oof.

00:04:19:08 - 00:04:19:11

Alasdair Milton

Yeah,

00:04:19:11 - 00:04:38:15

Alasdair Milton

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 little bit with that, no doubt. This is probably the most interesting time and certainly the most turbulent time in biopharma.

00:04:38:17 - 00:05:00:14

Alasdair Milton

We've got obviously the, 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.

00:05:00:16 - 00:05:25:17

Alasdair Milton

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 all of these complexities. And that's why they come to 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.

00:05:25:17 - 00:05:33:02

Alasdair Milton

The science keeps marching forward keeps moving forward no matter what. And that's always what gives me hope.

00:05:33:04 - 00:05:56:22

Christian Soschner

That good days and 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?

00:05:57:00 - 00:06:13:04

Alasdair Milton

That's a great question. It's really hard, I would say, to pick one. This is it's such an interesting time. I mean, if I how do I even pick one in terms of, like, 1 or 2 trends? I remember doing some work ten years ago in the obesity market.

00:06:13:04 - 00:06:16:07

Alasdair Milton

And at that time, it was really, it it's

00:06:16:07 - 00:06:16:20

Alasdair Milton

a dead end.

00:06:16:20 - 00:06:36:14

Alasdair Milton

The drugs didn't work very well. They had significant side effects. And and fast forward ten years and here we are with the impact of the top ones. Can I open it 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 of multi cancer early detection tests.

00:06:36:18 - 00:07:04:00

Alasdair Milton

Still early days. We have to tweak that technology. We're using a lot of testing in oncology to predict disease recurrence. And you know, help physicians understand, you know, when they should stop therapy. You know, for, 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, is is I spend a lot of time in the cell and gene therapy space.

00:07:04:00 - 00:07:31:15

Alasdair Milton

It's we have the first in vivo Car-T. So we have in vivo car in humans phase one trials ongoing. I think that that could be a significant game changer, because when I was doing my PhD 28 years ago, the idea that you could even have a target 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 a cure.

00:07:31:17 - 00:07:43:16

Alasdair Milton

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.

00:07:44:00 - 00:08:05:02

Christian Soschner

That the the good points, you mentioned GLP one and Car-T, and I think both technologies were teamed that for a very long time. And this is what's amazing for me in the industry, that innovation doesn't happen 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.

00:08:05:02 - 00:08:29:15

Christian Soschner

And I think it was still 1985 or something where they started and turned it down, brought it back, turn it down, brought it back, and suddenly you see the Spike Carthy pretty much the same. Why is the innovation? I want to hear your opinion based innovation in, in our industry, in the biopharma industry, not something that you can predict on a linear scale, we'll just say left, right, linear I every year, little bit of progress and we know what's coming.

00:08:29:17 - 00:08:38:04

Christian Soschner

Why does that happen in a way that is a straight line. Almost nothing. And then suddenly it works and we get to the results and it really changes the world for the better.

00:08:38:06 - 00:08:38:23

Alasdair Milton

Yeah,

00:08:38:23 - 00:09:03:00

Alasdair Milton

that's a great question. You know, I think you could almost tell in the story of gene therapy, which of the early 2000, there was a lot of promise in gene therapy. And then there was a trial where, there was a death, and, and that kind of killed that field for, for a number of years. And we couldn't optimize the dosage with the a, B vector because, we were seeing significant liver talks issues and those still plagued that, that market.

00:09:03:00 - 00:09:24:16

Alasdair Milton

But that, 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 we spent time tweaking the technology. The scientists went away. They figured out how to, you know, maximize the the payload without the talk side effects. You could almost say it was the same with the antibody drug conjugates.

00:09:24:16 - 00:09:42:20

Alasdair Milton

I mean, at that time, a number of years ago, ADCs, nobody was really investing in that area. It was very difficult to manufacture. You had 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

00:09:42:20 - 00:09:46:11

Alasdair Milton

again, super high area that everyone is investing in.

00:09:46:13 - 00:09:53:13

Alasdair Milton

So I think it's those incremental things you take, you know, you know, a couple of steps forward, one step back and then you take another couple of

00:09:53:13 - 00:09:59:08

Alasdair Milton

steps forward. And so the science keeps evolving. The science keeps maturing. And I think eventually we get there.

00:09:59:11 - 00:10:19:03

Christian Soschner

Yeah. Absolutely. Totally agree that 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, well, moment because we have regulation and everything's approved. And then the markets take it up and go to marketing. You mentioned selling Gene therapy.

00:10:19:03 - 00:10:26:23

Christian Soschner

You're excited about this and is excited to do most. Why did you decide for selling gene therapy.

00:10:27:00 - 00:10:27:12

Alasdair Milton

So so

00:10:27:12 - 00:10:35:17

Alasdair Milton

let's split them as well. Because people say selling gene therapy and I don't I don't like to say that they're very different. So that should be sell and it should be Gene.

00:10:35:17 - 00:10:39:09

Alasdair Milton

You know, their manufacturing is different.

00:10:39:09 - 00:10:47:06

Alasdair Milton

They're in markets are different. The patient population sizes are different. So let's just split them a little bit.

00:10:47:08 - 00:11:00:09

Alasdair Milton

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 about

00:11:00:09 - 00:11:13:12

Alasdair Milton

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, these patients who had no other options.

00:11:13:14 - 00:11:39:13

Alasdair Milton

And then 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, the idea that we can actually have a cure in many cases, which in, in other disease areas, even in oncology with the antibody drug conjugates with a lot of the new technologies, you get patients a little bit more time, but it's it's very hard to cure them.

00:11:39:15 - 00:11:45:17

Alasdair Milton

So cell in the cell therapy, the gene therapy space to me are just very, very exciting.

00:11:46:01 - 00:12:06:09

Christian Soschner

Absolutely. And so we have some challenges with with that later. A lot of topics you mentioned that, I liked in the preparation your, wording that the US potentially will lose or might lose its innovation crown. China is an upcoming market. Precision medicine is moving forward. And now today you're in the United States. But it didn't stop.

00:12:06:09 - 00:12:10:24

Christian Soschner

Still, can you share a story where it actually began?

00:12:11:01 - 00:12:11:13

Alasdair Milton

Yeah,

00:12:11:13 - 00:12:34:18

Alasdair Milton

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 the seal. Seal Island. Still, it's about 15 miles southwest of a town called Oban, which is, if anyone is watching this as a a whiskey fan, it's a very famous whiskey town in northern town in Scotland, rather.

00:12:34:20 - 00:12:58:16

Alasdair Milton

And so Seal Island is, I don't know, a couple of miles wide, 3 or 4 miles long. It's a population of about. When I was growing up there, maybe 3 or 400 people. So very, very small place. My dad was a fisherman. My mom worked in the local school, you know, solidly blue collar. And, you know, my dad, especially was very focused.

00:12:58:18 - 00:13:04:01

Alasdair Milton

I would go to university, was actually the first one of my family to go to university.

00:13:04:10 - 00:13:26:09

Alasdair Milton

Work one day and roll up your sleeves and, you know, you know, just go for your dreams, you know, just trying, you know, push, push on, push hard and try to achieve your dreams. That I loved growing up in Ireland. It was incredible. But there comes a time when you feel like you're a little bit. It's a little bit claustrophobic and you have to go into the big bad world.

00:13:26:09 - 00:13:29:19

Christian Soschner

How how was life on that island for you as a kid?

00:13:29:21 - 00:13:31:01

Alasdair Milton

Idyllic.

00:13:31:01 - 00:13:51:23

Alasdair Milton

Really. It really was is a great upbringing. Great friends, the kind of place where during the summer holidays, your mom and dad would kick you out the door. It's open in the morning on your bike. You go and play football, with your friends. Come back at 5:00 and, you know, very safe. It was it was a great, great place to grow up.

00:13:51:23 - 00:14:09:09

Alasdair Milton

So it was very, very lucky. But like I say, you I think you eventually, you know, I still have friends who live on the island who stayed within 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 in and do other things.

00:14:09:11 - 00:14:10:17

Alasdair Milton

So.

00:14:10:24 - 00:14:33:00

Christian Soschner

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 assume we are pretty much the same age, Gen-X, experiences the 70s and 80s and 90s, pre-Internet era.

00:14:33:02 - 00:14:43:10

Christian Soschner

What lessons can you take? What did you take from your childhood with you? Did software as an adult up to today?

00:14:43:12 - 00:14:44:06

Alasdair Milton

So, so I

00:14:44:06 - 00:15:04:17

Alasdair Milton

think, there's a level of consciousness in me in particular and a kind of discipline like I said, and, and resilience. I did a lot of swimming when I was a kid. So when I was about 8 or 9, I started swimming competitively. So I would have to be in the pool.

00:15:04:19 - 00:15:23:12

Alasdair Milton

You know, 6 or 7 in the morning, four days a week to train and then on the weekends of would swim competitively in Scotland. I mean, you're that young. It takes a lot of takes a lot of resilience and dedication. It's not easy to get up at that time in the morning, especially in the west coast of Scotland, where it rains a lot and in the winter, and it's very dark in the mornings.

00:15:23:12 - 00:15:44:07

Alasdair Milton

But, you know, I'd have to do that. And then I would go to school afterwards. And so that, that definitely has a lot of discipline. And, and you know, I'm just somebody who, who has that very levelheaded approach to life and, believes that, you know, you work hard, you keep your head down and, and, you know, you like I say, you achieve your goals.

00:15:44:09 - 00:16:12:15

Alasdair Milton

But definitely that, 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, you know, eight hours a week, sometimes you're not earning much money. Usually you're working weekends. And so a lot of that, that grit and determination that I took from my childhood actually translated very nicely into, you know what?

00:16:12:15 - 00:16:14:11

Alasdair Milton

I did a university.

00:16:15:08 - 00:16:44:19

Christian Soschner

That totally reminds me of my own life. The generation 70s, 80s said the excellent work ethic get up in the morning. Yeah. 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 gets the job done. In your opinion, when we look at today's world, I mean, there was always this discussion between work ethic and discipline is the most important part in building a successful biotech company.

00:16:44:21 - 00:17:10:10

Christian Soschner

When we look at it with 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 here where we all from, 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?

00:17:10:12 - 00:17:11:09

Alasdair Milton

Critical, I

00:17:11:09 - 00:17:26:19

Alasdair Milton

would say, especially as a consultant. You know, 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. I mean, this is not this is not a 9 to 5 job. You have to be willing to make sacrifices.

00:17:26:19 - 00:17:49:19

Alasdair Milton

You're on the road a lot. You work weekends, you know, you're you're in client services. And I think at the end of the day, that that discipline, that work ethic, the organizational, the organizational skills that are required are absolutely critical. Yeah. You got it. You got to be willing to, to really grind. I mean, you're a partner in a big for your, your your contributing to the partnership.

00:17:49:21 - 00:18:02:04

Alasdair Milton

And so you want to you want to be you want to be a good partner. And so, you know, everyone has to roll up their sleeves so that that hard work ethic is absolutely required in your, in your, in your career. No doubt. Absolutely no doubt.

00:18:02:14 - 00:18:23:04

Christian Soschner

I would like to stay a little bit on this area. Discipline, work ethic and resilience. This is a free pass. Words that very often come together. And then is the question from from kids about where can I run that? How do I get that? Where do I find the skills? You said that you were a competitive swimmer in your school.

00:18:23:06 - 00:18:29:20

Christian Soschner

Is sports like being a competitive swimmer helpful for developing the skills?

00:18:29:22 - 00:18:30:08

Alasdair Milton

I think

00:18:30:08 - 00:18:58:11

Alasdair Milton

so, I don't think it just has to be swimming. I mean, swimming's a little bit of a, a almost a unique sport in that you're 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.

00:18:58:12 - 00:19:23:24

Alasdair Milton

You know, 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 instill in me that the, the, the, the, the idea that, you know, go to university, get a good education.

00:19:23:24 - 00:19:37:10

Alasdair Milton

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 it's also a little bit about the sport. So the extracurricular activities as well.

00:19:37:22 - 00:19:51:24

Christian Soschner

That you have to read, you mentioned stats, then later you did your PhD. And your first consulting jobs. Could you, could you rely on that skill, stand in these jobs.

00:19:52:01 - 00:19:52:10

Alasdair Milton

Could I

00:19:52:10 - 00:19:59:02

Alasdair Milton

take what I learned and translate into the business world? Yeah. Sure. I think

00:19:59:02 - 00:20:17:19

Alasdair Milton

moving from a PhD into the business world, though, is, is that was one of the biggest jumps for me, was actually going from the lab into the corporate world. You know, you're in the lab, you're very focused on, you know, a particular main mechanism or molecular path where you're in the weeds.

00:20:17:21 - 00:20:38:02

Alasdair Milton

You pick the science, 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, of R&D doesn't take talk to the right hand of commercial right.

00:20:38:02 - 00:20:55:23

Alasdair Milton

And so they speak a different language. And so that was actually one of the biggest jumps for me was, 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.

00:20:55:23 - 00:21:16:11

Alasdair Milton

When I actually moved from the lab very briefly, I, I was a sales rep for Wyeth. Right. So she was 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 other roles.

00:21:16:11 - 00:21:17:22

Alasdair Milton

I had.

00:21:18:02 - 00:21:37:24

Christian Soschner

I think is an interesting points 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 to have a good idea, start in the lab and then move into the corporate world. Why is that so challenging for people?

00:21:37:24 - 00:21:49:04

Christian Soschner

How different data can you explain a little bit to life in the lab for you as a PhD candidate, and then how life changed when you were at the big company?

00:21:49:06 - 00:21:49:23

Alasdair Milton

Yeah.

00:21:49:23 - 00:22:23:06

Alasdair Milton

So so again, a PhD, right? You're you're you're a specialist in a particular area, but you're in the weeds. You're very detail orientated. You're very focused on particular mechanisms, pathways. Your area right. So super, super deep and not very wide. And then you go and you try and you know, go into marketing role or sales role in a pharma company where, like I say, it's a different language.

00:22:23:08 - 00:22:48:23

Alasdair Milton

The drivers are different. They're more focused on business outcomes, on ROI, on speed. And those are things that are very often you don't have in the lab. So that, well, there are some transferable skills from the lab to the business world. Add up to me was one of the biggest chunks was just learning that new language, learning about learning about companies, right.

00:22:48:23 - 00:23:08:24

Alasdair Milton

How our company is structured, what's a PNL, what's a balance sheet? Or we think about cash flow and there's no there's not anything that you're ever exposed to in your PhD. So 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.

00:23:08:24 - 00:23:29:02

Alasdair Milton

So I was very lucky. But, I would say I really cut my teeth in my first job beyond I was a sales rep for a little bit and then moved into a market research firm, and that's when I really started to cut my teeth in the farm industry. And that's where, you know, that's when my career kind of start to really accelerate.

00:23:29:04 - 00:23:34:20

Christian Soschner

Let's tell in between with your PhD, before we dive into, into the corporate,

00:23:34:20 - 00:23:50:22

Christian Soschner

but deeper, I read in your behind in your material that you not only worked in the lab, which you've always wanted, so it's more than a full time job, but you also had some chops beside it. How do you manage to do that?

00:23:50:24 - 00:23:52:16

Alasdair Milton

With great difficulty.

00:23:52:16 - 00:24:02:13

Alasdair Milton

Yeah it is. You're right, I am. I mean, like the PhD stipend is I think, gosh, mine was maybe $15,000.

00:24:02:13 - 00:24:07:01

Alasdair Milton

Yeah. Back in, in, in when I started in 99. So

00:24:07:01 - 00:24:16:13

Alasdair Milton

not a lot of money. Right. You really don't have much money. It's a PhD. You have to be. So it has to be something that you're really passionate about it.

00:24:16:14 - 00:24:34:22

Alasdair Milton

That cannot be something that you get out of bed every day and think, oh my goodness, I can't go to this, this lab again and do this all over again. If that's the case, you know, because the pay is terrible. And so I had to supplement that, that, that meager income with side jobs.

00:24:34:22 - 00:24:36:19

Alasdair Milton

So the weekend and I

00:24:36:19 - 00:24:39:16

Alasdair Milton

remember often working in the lab

00:24:39:16 - 00:24:46:08

Alasdair Milton

Monday to Friday fill days from, I don't know, six, seven in the morning till six, seven at night.

00:24:46:10 - 00:25:02:05

Alasdair Milton

And then I would go into the lab and maybe a Saturday or Sunday morning had some experiments running. I had to do some stuff there, and then I'd go and do a, a sales role. I had a sales job, working in different, stores in Glasgow. Yeah. Just just to earn a little bit more money.

00:25:02:07 - 00:25:18:22

Alasdair Milton

So, yeah, I mean, you do these things, I mean, it's, it's if you have that passion and that drive, then I look back. I was never happy. Right? We didn't have a lot of money. I just got married as well. So I don't have a lot of money. But you were happy. It was. It was. And I just I had that passion.

00:25:18:22 - 00:25:27:09

Alasdair Milton

I had that drive. And I think that really helped. And again, it came back to that discipline. And be willing to just roll up your sleeves. Right. Nobody's going to hand you something in life. You got to just

00:25:27:09 - 00:25:31:02

Alasdair Milton

do that. It's cool for yourself. Take risks.

00:25:31:04 - 00:25:45:07

Christian Soschner

Yeah, I totally agree. And I think this is a prime 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.

00:25:45:09 - 00:25:45:15

Alasdair Milton

That

00:25:45:15 - 00:26:03:12

Alasdair Milton

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

00:26:03:14 - 00:26:22:08

Christian Soschner

And it keeps opening doors for you. When you sum it up, what you said, you worked in the lab for passionate about your area, didn't make much money, but, close the gap with side hustle. And 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.

00:26:22:08 - 00:26:28:22

Christian Soschner

He understands the science. And he also hones, for the first time in his life, side skills.

00:26:28:24 - 00:26:49:01

Alasdair Milton

Yeah. I mean, it's so, 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.

00:26:49:06 - 00:27:07:22

Alasdair Milton

I actually applied to them before I got the sales role at Wyeth and was rejected because I had no experience. Oh, and they said that was tough, right? Because 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 to not get that job the first time.

00:27:07:22 - 00:27:14:20

Alasdair Milton

So that's why I went away. I got the experience with Wyeth, and then I went back to it, McKinsey a second time and then got that role. But again, it's just

00:27:14:20 - 00:27:16:20

Alasdair Milton

that tenacious ness.

00:27:16:22 - 00:27:22:08

Christian Soschner

So yeah dealing with rejection is an important part in sales I guess.

00:27:22:10 - 00:27:25:02

Alasdair Milton

Yeah I definitely.

00:27:25:04 - 00:27:38:18

Christian Soschner

But then when you look back to your material, you didn't decide to stop as a sales rep at Wyeth. You moved to Boston in 2007 and into a license company. How was that?

00:27:38:20 - 00:27:42:09

Alasdair Milton

Yeah. So. The left

00:27:42:09 - 00:27:50:04

Alasdair Milton

in 2005, I briefly worked with wife. And then I applied back to Wood Mackenzie and

00:27:50:04 - 00:28:06:08

Alasdair Milton

was taken on by them a second time in, later on in 2005. And so I work 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.

00:28:06:08 - 00:28:29:11

Alasdair Milton

So what's their geographic strategy, their business development strategy, their deals? We did a lot of forecasting work then financial analysis. And then they offered me the chance to move to Boston in 2007 for just a two year secondment. They were growing the US practice, and they needed some folks here. And so they offered me the chance to move over just just for a couple of years.

00:28:29:11 - 00:28:53:15

Alasdair Milton

But, things didn't really work out that way. We arrived here in it's actually, October, 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.

00:28:53:15 - 00:29:13:09

Alasdair Milton

They were just going to shut it down and pre Lehman's so the market was doing pretty well. They had just been acquired by a private equity firm and the oil and gas team, we only got to say that the business was doing really well. Life sciences was a small part of the businesses. Maybe 10% of the revenue, and they just decided to to close the whole thing down.

00:29:13:09 - 00:29:24:09

Alasdair Milton

So that was pretty crushing. We moved here like 3500 miles, and then within a few weeks, you're you're out of a job.

00:29:24:20 - 00:29:49:23

Christian Soschner

I can imagine that. This was a tough time. I mean, 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. But I would be interesting to hear from you. I think it is this life changing moment when you look forward to something and when you really appreciate that, move forward, and then suddenly things change.

00:29:50:00 - 00:30:00:22

Christian Soschner

Many people are in shock and need a very long time to process it. What did it help you? What techniques did you develop to process the shock and move forward?

00:30:00:24 - 00:30:01:22

Alasdair Milton

I think it's

00:30:01:22 - 00:30:22:15

Alasdair Milton

a great question. Yeah. I mean, one of the biggest lessons I took was that your career is never linear and that you, you find that one door closes and actually another one opens. And when that door closes at the time, it can seem like the end of the world. But when I look back now, there's really one of the best things that happened to me.

00:30:22:17 - 00:30:32:24

Alasdair Milton

You know, if I hadn't lost my job with McKinsey, I probably 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

00:30:32:24 - 00:30:40:19

Alasdair Milton

again, I keep I feel like I'm like a broken record with the resilience and the tenacity, like I always wanted to come and work in the States.

00:30:40:19 - 00:30:45:20

Alasdair Milton

Right. That was my drive. I didn't necessarily want to live here forever, but I was was willing to go

00:30:45:20 - 00:31:03:12

Alasdair Milton

in a two year economy. And that was just so exciting to me. Right. The idea that I could come here, be exposed to new culture, learn 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.

00:31:03:12 - 00:31:24:20

Alasdair Milton

And so again, I come back to the tenacity, the resilience. And if you have a drive, you have a goal. You're going to say, okay, that that's not I'm not going to let this be the end of the story. And so ultimately the the life sciences team, the research side of the team at least was bought out by by a company called Decision Resources.

00:31:24:22 - 00:31:41:11

Alasdair Milton

And I started my new job on the 1st of January, 2008. So within just three months of arriving in the US, I lost the job, got a new job, and, and and that was a big decision, right? My wife and I had had a big decision to make. Do we go back, you know, do we go back to the UK?

00:31:41:11 - 00:31:58:06

Alasdair Milton

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 going to 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 the here for the next few years?

00:31:58:08 - 00:32:18:00

Alasdair Milton

And so ultimately we decided we would try and make a go of it. And it was not easy at all. I mean, we we spent a number of years where my wife in particular struggled. She was a her is a nurse. She had worked in, always been an oncology nurse. She had worked in the, the in the UK at the Beatson in Glasgow.

00:32:18:02 - 00:32:33:11

Alasdair Milton

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 and hard. And so it was a, it was a tough few years. You don't really know anyone. You don't have that many friends.

00:32:33:11 - 00:32:41:04

Alasdair Milton

But again, this is the resilience and that pushing that drive this can of just in you that can pulls you through. I think a little bit.

00:32:42:08 - 00:33:02:24

Christian Soschner

Yeah. And you mentioned the broken record. I think we can't play this broken record over and over again. And, not enough times. This is exactly how you how you become resilient for later in life. I mean, 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.

00:33:02:24 - 00:33:07:08

Christian Soschner

Because to know I have all what I need to move forward.

00:33:07:10 - 00:33:26:02

Alasdair Milton

Yeah, I don't have a lot of patience for people in life that want to just be handed things. I know it's it's not in my DNA. It's it's, it's that Scottish grit and determination that that, kind of pulled us through. So, you know, things worked out well in the end, but it was a it was a tough 4 or 5 years, I would say.

00:33:26:04 - 00:33:33:21

Christian Soschner

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

00:33:33:23 - 00:33:57:10

Alasdair Milton

That's a no. I mean, we're, we're we're a nation of immigrants. I mean, most I think that I don't know how many people in the, in, around the world can claim Scots heritage. And there's a significant number of US presidents that can claim Scots heritage. But, you know, we're we're a nation that's that's always pushed out of our own comfort zone, our own four, four walls.

00:33:57:12 - 00:34:28:16

Alasdair Milton

A significant number of folks obviously left through the, the 17th and 18th centuries. They go to Australia, Canada, US. We've always been a nation of immigrants. You know, Andrew Carnegie, who was one of the most successful businessmen of all time, was born in Dunfermline in Scotland. So I just I think we're just, we're, we're a nation that likes to go and explore and see what sets there are around country, some sometimes by choice and sometimes, not by choice.

00:34:28:18 - 00:34:53:09

Christian Soschner

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

00:34:53:11 - 00:35:16:11

Alasdair Milton

Yeah, so so when I came to the US and was with Decision Resources, I ultimately ended up leading the analyst team. And so I, 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. Wyeth and then Wood Mackenzie and and learning the business.

00:35:16:13 - 00:35:37:21

Alasdair Milton

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.

00:35:37:21 - 00:36:02:09

Alasdair Milton

And so that's when I decided to move over, move over into more of a direct consulting roles. So but at each stage of that journey, there's been, the evolution and the learning new skills and, and embracing that 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.

00:36:02:09 - 00:36:21:19

Alasdair Milton

I can't step into this role or I'm not good enough. And I always say, just go for it. Just, just, just go for it. I mean, 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 going to just go back to the UK and and you know, if you've got that drive and that focus and, that tenacity, then you just you just keep going.

00:36:21:21 - 00:36:37:09

Alasdair Milton

So I but I've learned I continue to learn, right. Even as a partner in a big for 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.

00:36:38:16 - 00:37:03:19

Christian Soschner

I couldn't agree more. Passion is more important than skill 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. Yeah, when we look at your career, what person has the most impact on your life?

00:37:03:20 - 00:37:15:01

Alasdair Milton

I'm going to say my wife. Yeah. And I've had I've had some phenomenal mentors. I've got, I've got great mentors here, at KPMG. And I've had

00:37:15:01 - 00:37:26:11

Alasdair Milton

great mentors through my career. But, when terms of who's had the most impact, I think has to be my wife because she didn't really want to leave Scotland, she's very close to her family.

00:37:26:13 - 00:37:42:02

Alasdair Milton

It was tough for her to leave. And you're, you're 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 shouldn't have been to before, that she didn't know anyone. You know, I'm at work in here in this new role. And she's stuck in the apartment.

00:37:42:02 - 00:38:04:09

Alasdair Milton

She couldn't work. At the time, we didn't have kids. And so she sacrificed a lot. I mean, 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's very hard for for and nurses to actually successfully train, over here and get the qualifications again.

00:38:04:11 - 00:38:30:00

Alasdair Milton

But she did that. She took on other part time jobs and now she's a, she's one of the, the, the, the, the, oncology nurses and the oral chemotherapy unit here in in the Dana-Farber, in Boston. So, you know, she's pushed on hard. She's 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.

00:38:30:02 - 00:38:30:24

Alasdair Milton

To be quite honest.

00:38:31:20 - 00:38:39:21

Christian Soschner

The congratulation great Trinity community did together from from Scotland to Boston, United States, and it just kept going.

00:38:39:23 - 00:38:44:03

Alasdair Milton

You just keep going. Just get your head down. Keep going. Never give up. Never.

00:38:44:03 - 00:38:55:23

Christian Soschner

Yeah. 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?

00:38:56:00 - 00:38:56:14

Alasdair Milton

I think it's

00:38:56:14 - 00:39:17:11

Alasdair Milton

going to be I think it's going to be that three month period. When we came here and things fell apart, it was it was absolutely. It was devastating. Because you you have left behind your friends and family and you've come to this, country that you, you know, you don't know anyone, and and you, you all of a sudden they're cut adrift.

00:39:17:13 - 00:39:22:08

Alasdair Milton

That was a really tough time. That was a stressful time. I wife

00:39:22:08 - 00:39:31:16

Alasdair Milton

and I, we're actually talking about it the other day because it's, is. But just about the 18th year anniversary since we came here, and we were talking about how I. She went home for Christmas that year,

00:39:31:16 - 00:39:39:05

Alasdair Milton

and I had to stay here and trying to figure out, like, this new role, should I move over to decision resources.

00:39:39:06 - 00:40:00:11

Alasdair Milton

You know, what's going to happen? What does the contract look like? Just a lot of stuff going on and eventually got back to the UK. And like Christmas, I think there's a 23rd or 24th of December. Her birthday is Christmas Eve, so landed back in the UK. I have to, like, take a, I think I ended up taking a bus from, like, Heathrow up to Glasgow.

00:40:00:13 - 00:40:22:07

Alasdair Milton

But. So that that period was just really hard, like some big, big life choices. I mean, you have this fork in the road almost, and you don't quite know which way it's going to go, like what happens if you make the wrong decision. So that that to me was definitely the toughest, toughest time. Yeah. Because you're impacting someone else's life as well.

00:40:22:07 - 00:40:23:23

Alasdair Milton

It's not just me.

00:40:24:02 - 00:40:46:11

Christian Soschner

So I think what's also interesting for me, driving a little bit deeper in these decision making, situations in life, do you have a tough time? You have many roles to do. 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.

00:40:46:13 - 00:41:05:08

Christian Soschner

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? But, habits or mind trick to develop to keep you going through such tough times?

00:41:08:20 - 00:41:10:09

Alasdair Milton

I, I think

00:41:10:09 - 00:41:27:18

Alasdair Milton

we we, I mean, we really sat down and thought carefully about the different paths. I don't, I think the sheer I could see 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

00:41:27:18 - 00:41:30:18

Alasdair Milton

career if I went back to the UK.

00:41:30:20 - 00:41:33:24

Alasdair Milton

Right? Because what what was what was I going to do? I just lost my job.

00:41:33:24 - 00:41:48:11

Alasdair Milton

I was going to have to reapply for other jobs with other companies. It was going to 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.

00:41:48:11 - 00:42:05:15

Alasdair Milton

And so you it's hard. I, 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 in Europe. 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.

00:42:05:15 - 00:42:23:04

Alasdair Milton

And so things just snowballed from there. That was kind of how we we approached it. We just couldn't see a path forward for us in the UK. It just it just wasn't going to 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?

00:42:23:06 - 00:42:41:05

Alasdair Milton

Do you start to make friends here? Do you start to reach 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, you know, that's when things start to kind of snowball and you're like, okay, we're going to be here for, for, for for the foreseeable.

00:42:41:05 - 00:42:42:17

Christian Soschner

So

00:42:42:17 - 00:42:48:02

Christian Soschner

the congratulations to your family. They are now, ten 1014.

00:42:48:04 - 00:42:50:13

Alasdair Milton

12 and 14. Yeah. Yeah.

00:42:50:15 - 00:42:54:00

Christian Soschner

So it's it's still in school, started school, still in scale.

00:42:54:02 - 00:42:54:10

Alasdair Milton

Yeah.

00:42:54:10 - 00:42:54:18

Christian Soschner

Ten

00:42:54:18 - 00:43:15:00

Christian Soschner

times. Yeah. The points that you mentioned are really good. I 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 don't throw in the towel too, too early. Don't give in to temporary emotions. They don't last forever.

00:43:15:02 - 00:43:16:22

Christian Soschner

Sometimes the change.

00:43:16:24 - 00:43:31:05

Alasdair Milton

Yep. And you'll 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 that will pay dividends.

00:43:31:07 - 00:43:44:09

Christian Soschner

But is that easy? I mean, fear, hard emotions in such a situation, how do you turn off your mind? I turn on your mind. It's turn off the emotions.

00:43:44:11 - 00:43:44:19

Alasdair Milton

I think

00:43:44:19 - 00:43:59:05

Alasdair Milton

you just have to leave the options in many ways. I mean, for me, it is a case of the good and the bad. Like, what were the. What was the good in the bad of going back to the UK? What was getting the bad of staying here? At the end of the day, let's say so we decide to stay here and we don't like it.

00:43:59:05 - 00:44:00:00

Alasdair Milton

After six months

00:44:00:00 - 00:44:08:21

Alasdair Milton

or 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

00:44:08:21 - 00:44:18:24

Alasdair Milton

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.

00:44:18:24 - 00:44:38:17

Alasdair Milton

I had to really kind of see this through. I didn't think back in 2008 that I would still be here, 20 years later. It was just that journey that we that we took, I mean, quite as easily of just blown up after six months. But at least I had the time then to think about what was the path.

00:44:38:21 - 00:44:43:02

Alasdair Milton

You know, that was the logical part. That was a logical part of me as a scientist. And the way I just process

00:44:43:02 - 00:44:46:22

Alasdair Milton

information and make decisions. So I just sit down and think in a

00:44:46:22 - 00:44:53:11

Alasdair Milton

in a cool, collective and calm manner, if you can. What what are the different paths looked like and what's the best option?

00:44:53:16 - 00:45:14:21

Christian Soschner

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 obviously an up and down. It's never a straight line, but when you know how to survive the hard times with, as you said, just sit on, breathe, think about it, lay out your options, make a decision for them.

00:45:14:23 - 00:45:26:13

Christian Soschner

But also on the other side, when companies are super, 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.

00:45:26:15 - 00:45:27:15

Alasdair Milton

And I

00:45:27:15 - 00:45:48:17

Alasdair Milton

think that's another important part to this 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 Alister and his wife making this decision.

00:45:48:18 - 00:46:22:20

Alasdair Milton

We we 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 also spoke to family about the options as well. But take it, 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.

00:46:23:03 - 00:46:31:07

Christian Soschner

That's a very good point. And is it still valid in the world?

00:46:31:09 - 00:46:35:01

Alasdair Milton

I think so, yeah, yeah.

00:46:35:03 - 00:46:43:17

Christian Soschner

So we need humans. At the end of the day, human advice is, irreplaceable.

00:46:43:19 - 00:46:44:20

Alasdair Milton

Yeah, I do, I

00:46:44:20 - 00:46:51:06

Alasdair Milton

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.

00:46:51:06 - 00:46:54:06

Alasdair Milton

Who can who can give good counsel?

00:46:54:06 - 00:47:04:13

Alasdair Milton

Let's see where that AI takes us in the next 5 or 10 years. But at the moment, I still think that the human voice is, is still is still trusted so much and

00:47:04:13 - 00:47:06:18

Alasdair Milton

is required now.

00:47:06:20 - 00:47:09:14

Alasdair Milton

Things can help inform some of the decision making.

00:47:09:14 - 00:47:14:09

Alasdair Milton

But at the end of the day, I think it requires the human voice.

00:47:14:17 - 00:47:39:18

Christian Soschner

I totally agree, I think you had this, replacement all the time before end. Innovation, psychics, internet. But at the end of the day, we need to the humans. Let's 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?

00:47:39:20 - 00:47:40:19

Alasdair Milton

What am I doing at KPMG?

00:47:40:19 - 00:47:58:02

Alasdair Milton

Well, let me let me just back up and talk a little bit about KPMG overall in case there's anyone on the podcast is not familiar with the firm. So we're 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.

00:47:58:04 - 00:48:19:08

Alasdair Milton

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, you know, first of all, to transform their business. So that could be through new technology or just making their operations more efficient and run better.

00:48:19:10 - 00:48:43:22

Alasdair Milton

The second thing we do is performance improvement so we can 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.

00:48:43:22 - 00:49:10:16

Alasdair Milton

So helping different functions work more effectively together. And then a large part of what, the team that I'm part of does is, is deals, right? So, we, we help clients either buy or sell parts of the buy companies or so parts of the business to work with them through the entire process. We do all their upfront due diligence, operational, financial, commercial, it right through the deal lifecycle.

00:49:10:16 - 00:49:37:24

Alasdair Milton

We help them integrate the new company once the deal is done, or we'll help them carve out, a piece of the business of their sale and and divestment piece of the business. And we work with pretty much everyone in the life sciences world. So we do work from, with the smallest biotechs to the biggest biopharma companies, medtech labs, academic medical centers, diagnostic companies, life science tools, and the other thing, it's also global.

00:49:38:01 - 00:49:43:18

Alasdair Milton

And so we are roughly 6500 people in health care, life sciences,

00:49:43:18 - 00:49:47:21

Alasdair Milton

globally in the firm. So it's a significant, significant

00:49:47:21 - 00:50:07:13

Alasdair Milton

team overall and globally. And that's important because we do a lot of international deals. And I often described as, a boutique inside a big for so my specific team. And the reason is because we're staffed people like myself who have very deep scientific backgrounds.

00:50:07:13 - 00:50:37:17

Alasdair Milton

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 white. And that's why a lot of us eventually moved to the to because, and to larger firms is because we wanted to exposure to the international aspect of work that truly transformational corporate work.

00:50:37:19 - 00:50:59:18

Alasdair Milton

But I think that that that boutique mindset is actually really a key differentiator for us because we we come with the scientific background, we can translate it into business reality for our clients. And our clients still want just advisors are going to show up and tell them what they already know. They want to be the US, to be challenged and to bring fresh ideas.

00:50:59:18 - 00:51:03:06

Alasdair Milton

So that's that's what I do here at PMG.

00:51:04:10 - 00:51:20:11

Christian Soschner

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

00:51:20:13 - 00:51:21:20

Alasdair Milton

That's

00:51:21:20 - 00:51:41:02

Alasdair Milton

that's a good question. I mean, again, we're a huge organization, right? So if 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.

00:51:41:02 - 00:51:45:18

Alasdair Milton

And that's the beauty of the big four, like having that skillset. Somebody who can

00:51:45:18 - 00:52:08:21

Alasdair Milton

talk that specific need. I mean, I think it goes where I typically do a lot of my work is in, in, in the pure strategy space. So helping biopharma companies launch new products or improve ways of working or, if they're entering new therapeutic area, help them think through portfolio optimization.

00:52:08:23 - 00:52:30:03

Alasdair Milton

Obviously, they do a lot of the deal work, mostly on the commercial due diligence. What the triggers are is very client dependent. I mean, again, we we work across the entire spectrum. So each of those clients has a different need, you know, a big biopharma clients right now to grappling with the one shoring of supply chains and the impact of tariffs and the uncertainties around the IRA.

00:52:30:03 - 00:52:51:06

Alasdair Milton

And so they're they're problems are a little bit different from Clay Science tools company that might want to carve out part of this business to redeploy the capital. And, 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 and in the four walls of KPMG that can support them.

00:52:51:13 - 00:53:10:24

Christian Soschner

I mean, your team must have an excellent experience. You mentioned that, you had a variety of roles before KPMG and in KPMG, you know, the only work with big pharma companies, but also with smaller biotech. So you really have a holistic overview about the entire value chain from lab bench to the market.

00:53:11:01 - 00:53:11:23

Alasdair Milton

Yep.

00:53:11:23 - 00:53:33:24

Alasdair Milton

We do. Yeah. I mean, look, we we support our smallest biotechs. And it could be we'll help them think through the equity story for capital raise will help them think through valuation services will help them think through tax implications. Will help them for IPO readiness. Obviously we we could be one of the we could be their auditor.

00:53:33:24 - 00:53:51:15

Alasdair Milton

So that's, you know, a specific set of offerings we have from the small biotechs. And then we'll help, you know, grow or transact, maybe there we go in the sale side and they sell to Big Pharma will work on that deal. And for a big pharma clients again, it's it's a completely different set

00:53:51:15 - 00:53:56:19

Alasdair Milton

of needs. But we're able to see the end to end right of the whole ecosystem

00:53:56:19 - 00:53:57:22

Alasdair Milton

because they all interact.

00:53:57:22 - 00:54:20:17

Alasdair Milton

Right. This the ecosystem is, is supported by the small biotechs that, you know, get that funding it 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 medtech, the labs where the tests have to be run.

00:54:20:17 - 00:54:36:13

Alasdair Milton

So, you know, an interconnected web of 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 you see the whole 360 degrees of the life sciences, market.

00:54:36:19 - 00:55:13:06

Christian Soschner

And companies have and this is one of the parts of the defense of 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. The academic world and then when people have the idea to move, it doesn't matter if it's a diagnostic or a track multiple once the patient, when we stage drug development, you come into preclinical development and we just sit proudly and it's a complete new ecosystem and it needs people like you can translate that and say, look, you have new challenges, then clinical space design, then you have regulatory shock period.

00:55:13:06 - 00:55:17:06

Christian Soschner

And then you have this market, scale up.

00:55:17:08 - 00:55:17:19

Alasdair Milton

Yeah,

00:55:17:19 - 00:55:49:13

Alasdair Milton

yeah. And 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, we've been 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.

00:55:49:15 - 00:55:56:12

Alasdair Milton

I think that's the power of of a firm like KPMG. Yeah. And that's why that's why I came here.

00:55:56:16 - 00:56:10:07

Christian Soschner

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

00:56:10:09 - 00:56:10:14

Alasdair Milton

Yeah,

00:56:10:14 - 00:56:32:19

Alasdair Milton

that's a great question. So let me let me ground it in a kind of project I did a few years ago. It was a midsize 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.

00:56:32:21 - 00:56:59:17

Alasdair Milton

And so we were brought in to do the commercial due diligence of the target. And so you're all all of a sudden faced with, 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.

00:56:59:17 - 00:57:22:12

Alasdair Milton

And so we all we actually all was started with a, a one on one 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, RV manufacturing, like what does that mean for your business?

00:57:22:12 - 00:57:43:24

Alasdair Milton

It means you're going to have to set up a new type of manufacturing. It means you're going to have to, you know, think about you know, this is manufactured in this country, okay. But it's then going to have to be shipped to another country for fill finish. What does that mean from a tax perspective? Stream and customs. But being able to translate all that into a very simple business framework was absolutely critical.

00:57:43:24 - 00:58:03:17

Alasdair Milton

We actually started almost with the one on one of what gene therapy was. But again, 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?

00:58:03:19 - 00:58:19:03

Alasdair Milton

What does it mean to have new skill sets that you might have to hire? What does it mean from a manufacturing in 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.

00:58:19:03 - 00:58:22:20

Alasdair Milton

But framing it around the implications for the business.

00:58:23:19 - 00:58:40:12

Christian Soschner

Let's take it a bit at this point that you mentioned, I see this very often. That's, it I don't think it's well understood. You mentioned you have a complex science on one hand and, academic writing, it creates, it's a skill set and it's an environment. And then on the other hand, we need to explain it in simple terms.

00:58:40:12 - 00:59:07:14

Christian Soschner

When it comes to business strategy and public markets realities and boardroom strategies and very often see that, it's a little bit confusing. So why is this complex science? Why do we need to, simplify practically down for people when they all have their PhDs and basically are in a good position to understand desired designs? From your perspective, why is this, simplification in the process so important in business?

00:59:07:16 - 00:59:07:24

Alasdair Milton

Because

00:59:07:24 - 00:59:31:15

Alasdair Milton

most of the time you're not presenting to folks with PhDs who are not scientists, right? You're presenting to the CEO, the CFO, the CEO, 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.

00:59:31:15 - 00:59:58:00

Alasdair Milton

But depending on the sophistication of the investor, they don't necessarily know the science. So that's why so important. And I always 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 going to be really hard to sell or that test isn't going to work.

00:59:58:00 - 01:00:18:19

Alasdair Milton

And here's why. And yet, the two just can't always seem to meet up and, and kind of and decide on a path forward. That that disconnect is, is palpable. And so that's where we help bridge that gap, right, is to bridge that gap between the science in translating it into the commercial impact.

01:00:19:04 - 01:00:27:20

Christian Soschner

Now, 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.

01:00:27:22 - 01:00:28:21

Alasdair Milton

Yep. Exactly.

01:00:28:21 - 01:00:55:09

Alasdair Milton

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

01:00:55:14 - 01:01:11:10

Christian Soschner

Yeah. And I totally agree. I think this is a unique the difference between European mindsets and the US mindset. When you look at the port 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.

01:01:11:10 - 01:01:19:05

Christian Soschner

And people who want to be successful with a track towards the market need the business side. It's pretty much simple.

01:01:19:07 - 01:01:21:04

Alasdair Milton

Yep.

01:01:21:06 - 01:01:34:06

Christian Soschner

When we look a little bit ahead, into the future, shaping the future of biopharma strategy in the next 5 to 10 years, where do you see it going?

01:01:34:08 - 01:01:36:19

Alasdair Milton

Do you mean from a personal perspective.

01:01:36:21 - 01:01:39:06

Christian Soschner

From the perspective of your team? From it? Yeah.

01:01:39:09 - 01:01:42:20

Alasdair Milton

KPMG yeah, I can probably I can

01:01:42:20 - 01:02:06:13

Alasdair Milton

probably frame it 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, 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 and places like China.

01:02:06:15 - 01:02:34:16

Alasdair Milton

They're facing huge pain. Cliffs. They need to use M&A to refresh and fill those pipeline gaps. Internally. There's a lot of cost cutting going on. A lot of layoffs, literally right sizing the organization. They're thinking about how they maybe launch new complex therapies like selling gene therapies, precision medicines. They're grappling with things like embedding AI and being more digitally aware.

01:02:34:16 - 01:02:54:09

Alasdair Milton

Had 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 you think about the strategy in the next 5 to 10 years?

01:02:54:09 - 01:03:02:23

Alasdair Milton

We're already doing it. We're already in there helping them. These, these big problems. And I think again, I come back to the power of a firm like at KPMG, where I can pull in people

01:03:02:23 - 01:03:12:02

Alasdair Milton

from from any parts of the firm to help. So if it's a bit supply chain, I'll bring in our supply chain team. If it's about tariffs, they'll bring our trade and customs and our tax experts.

01:03:12:17 - 01:03:39:22

Alasdair Milton

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, come back to this smaller American 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 their partner through the entire lifecycle.

01:03:39:22 - 01:03:47:16

Alasdair Milton

So when we think about ship in the future, a biopharma strategy where we're kind of already doing it in in many ways through a lot of the work right now.

01:03:48:12 - 01:04:06:04

Christian Soschner

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 if 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.

01:04:06:04 - 01:04:45:24

Christian Soschner

Suddenly the bank 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 knowhow from 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.

01:04:45:24 - 01:04:48:00

Christian Soschner

This is really amazing what you can do.

01:04:48:02 - 01:04:48:22

Alasdair Milton

Yeah,

01:04:48:22 - 01:05:00:24

Alasdair Milton

yeah, I mean, it's we're a huge organization. I think, like I say, a 6500 just in health care, life sciences. I mean, maybe 300,000 globally.

01:05:00:24 - 01:05:13:03

Alasdair Milton

If I'm right there, you know, $30 billion organization, it's, it's a huge it's a huge firm, and so, yeah, I mean, there's there are people here who do very easy things, right?

01:05:13:03 - 01:05:28:02

Alasdair Milton

They just they just do one specific area, keep it related to HR, keep it 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 firm who does.

01:05:28:04 - 01:05:38:15

Christian Soschner

But I'm curious to learn based on this, what you just said. How do you approach a problem with your team?

01:05:38:17 - 01:06:07:20

Alasdair Milton

I'm a old school, type consultant who likes to sit down and whiteboard problems with my team, and, that's that's coming. But 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 mean, 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.

01:06:07:22 - 01:06:43:22

Alasdair Milton

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 by 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 a hypothesis, come back.

01:06:43:24 - 01:07:09:02

Alasdair Milton

So that's, I would say, been a good thing, over the last year or so from, from the firm's perspective is bring a lot of our folks back 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 colleagues, we'll speak to different experts in the market, whether it's peers or physicians or pathologists or whoever it might be.

01:07:09:04 - 01:07:35:02

Alasdair Milton

You know, we'll run a lot of those research external research campaigns to then test the hypothesis. We obviously deal with a second of 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 ask them about different tests and the types of, test are using.

01:07:35:02 - 01:07:57:00

Alasdair Milton

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 all of that proprietary information. So it's a mix of the proprietary, the external the primary research the secondary and then bringing it all back together. And to break that problem and get the solution for the client.

01:07:57:18 - 01:08:17:14

Christian Soschner

Good points. There was one cure that I would like to pick up. This is remote working and working in the office. I have my opinion about the topic. I would like to hear 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.

01:08:17:14 - 01:08:28:18

Christian Soschner

I would like to hear your opinion on that. Why do you think the office work still has a place in this world? It's now interconnected. Why is that important?

01:08:28:20 - 01:08:37:13

Alasdair Milton

For a number of reasons. I mean, okay, we just talked about from a team perspective, it's been really hard for our junior teams who who came into the firm during

01:08:37:13 - 01:08:50:11

Alasdair Milton

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 to it's, almost like hundreds more steps, right?

01:08:50:11 - 01:09:10:14

Alasdair Milton

You learn through osmosis. You learn from being together. There are things that, you know, if somebody's sitting next to me, they can just lean over and ask that question. But if I'm virtual, they 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.

01:09:10:16 - 01:09:30:03

Alasdair Milton

From a leadership perspective, it's important to show junior staff that you're in the office, that you are a leader, that they are. 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 that might be be be getting from their clients? Right.

01:09:30:03 - 01:09:52:10

Alasdair Milton

So if I'm in the office and I'm speaking to someone in our practice or in our practice, our accounting advisory services or tax practice, you know, being present and being with them in the office, I can pick up, some potential opportunities for, for, for the work there and doors that they might be able to open. So I think that's why the and the in-person to me is so important.

01:09:52:18 - 01:10:03:15

Christian Soschner

Yeah, I think the creative 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, the downloads to information. And

01:10:03:15 - 01:10:25:16

Alasdair Milton

When I look at the industry, we had a extremely great time. From 2020 to 2022, everything went up. And then came the huge for 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?

01:10:25:18 - 01:10:26:13

Christian Soschner

Okay,

01:10:26:13 - 01:10:45:17

Christian Soschner

so let me frame us. I'm going to pull up just a couple of slides to help clean the discussion. I can talk a little bit about, Big Pharma and also what we're seeing with the small biotechs as well. So let me just pull up a slide here that can help drive the discussion.

01:10:45:22 - 01:11:07:08

Christian Soschner

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 is 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.

01:11:07:08 - 01:11:30:19

Christian Soschner

They have to fill the pipeline. So with this chart here, let me just explain what 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 this the size of the bubble.

01:11:30:19 - 01:11:54:19

Christian Soschner

So a couple of caveats. This is this is outright M&A. It's not any kind of partnerships or R&D collaborations. It's only M&A 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 and the deal.

01:11:54:19 - 01:12:14:18

Christian Soschner

So if the target had one commercial asset and they had one phase one asset, we came to 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 which was higher, was pretty high even in preclinical.

01:12:14:18 - 01:12:47:18

Christian Soschner

So you know, you can see there was no deals done at all for market assets in 2020 for 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, JNJ acquisition of intracellular, which is a CNS company for around 13 or 14 billion at the start of 2025.

01:12:47:20 - 01:13:10:23

Christian Soschner

And so we've seen a little bit more of a focus in 2025 when it was commercialized or kind of near commercial assets and 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.

01:13:11:00 - 01:13:37:14

Christian Soschner

An example would be have the acquired and in vivo Car-T company called Cap Stanford about $2 billion. That assets in phase one, then also in the in vivo Car-T space is made $1 billion acquisition of a pre-clinical company called Easel Biotech and then JNJ. Just recently, just, in mid-November, they acquired a company called Hold Up for about 3 billion for its phase one prostate, asset.

01:13:37:14 - 01:13:58:05

Christian Soschner

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 that are platform deals. So it's not like pharma is going to spend $1 billion on a single asset company that they're buying on platforms that they're hoping can produce multiple new molecules.

01:13:58:07 - 01:14:29:20

Christian Soschner

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 then contingency value rates. So if you look at the M&A 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 or and have had contingent payments attached.

01:14:29:22 - 01:14:57:06

Christian Soschner

But they also vary. So JNJ paid I think 85% upfront with just a 15% contingent on its proteomics deal. Last year, Novo paid around 30% upfront, with the majority of the deal value tied to earnings with the Cartier Cartier 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.

01:14:57:08 - 01:15:28:21

Christian Soschner

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 can de-risk by tying the total deal value to take some clinical and regulatory milestones. 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.

01:15:28:21 - 01:16:02:09

Christian Soschner

One slide for the private market. The story I think, is really for 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 in series A in the US and EU comparing the first half of 2025, to the same period in 2024, which is what what we have on this slide now, the second quarter of this year, we really saw a huge drop off in seed in series.

01:16:02:09 - 01:16:22:10

Christian Soschner

A investment in 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 that was mostly due to a handful of mega deals. About $2 billion of the capital came from just six deals. And that really skewed the picture. And then we came to Q2.

01:16:22:12 - 01:16:42:01

Christian Soschner

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. The investors do not like uncertainty. And, you know, we don't have the data here, but I can tell you that Q3 for first financings, it's up a little bit, but it's really still not great.

01:16:42:01 - 01:17:07:19

Christian Soschner

So you know, early stage biotech is in a really tough spot. I think from where we sit and KPMG, we're seeing VCs, they're still looking at preclinical companies, but they want to see AI in the enabling studies. Or ideally, you know, those studies are done. They're looking for companies that have their CMC in order, especially if you're in a complex modality like selling gene therapies.

01:17:07:21 - 01:17:36:10

Christian Soschner

They're favoring what I would think of as more experienced C-suite 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, you know, frankly, did not have the right management teams in place. They didn't always have good science either. So, you know, 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, you know, companies that are less risky.

01:17:36:10 - 01:18:00:01

Christian Soschner

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 signs, maybe even have a pharma partner on board. So, you know, look, if you're a founder and with an idea, no data. Things are, I think, really, really tough. And I we look at the private market or sorry the public markets.

01:18:00:03 - 01:18:19:09

Christian Soschner

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.

01:18:19:11 - 01:18:41:00

Christian Soschner

I think companies are finally getting some reward for good data readouts. I think the M&A activity that we've 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.

01:18:41:00 - 01:19:01:02

Christian Soschner

They flamed out. I think that helps the sector move a lot higher overall. So like all that 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 ELB Pharma. They raised a million. So we're seeing 1 or 2 companies go public.

01:19:01:02 - 01:19:21:24

Christian Soschner

But you know, nothing like we saw a few years ago. And I think a lot of biotechs are still thinking of a smart exit is through acquisition by pharma, rather than go to the public markets, or partnering with pharma to get that capital infusion as well. So, you know, overall private companies, it's mostly de-risked companies with solid data and management there.

01:19:21:24 - 01:19:40:11

Christian Soschner

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, IPO's are still way down. And I think, you know, things are still really fragile. So it probably wouldn't take much to send that the xbi back down again.

01:19:40:11 - 01:19:48:18

Christian Soschner

So that's kind of what we're seeing from the the pharma and the biotech in terms of the deal trends. Let me just take these slides down as well for a second.

01:19:52:03 - 01:20:09:07

Alasdair Milton

Last slide stuck right. Can you can you pull it up again? I have a few questions to that. Sure. I mean, you said we have 1 or 2 IPOs, so it's, we need to start somewhere. And it's good that, IPOs are coming back. Can you go on the first slide? I think you're just for my understanding.

01:20:09:07 - 01:20:11:01

Alasdair Milton

If I read it right, it looks to me when you look at

01:20:11:01 - 01:20:31:16

Alasdair Milton

2015, there were a lot of late stage deals. So I approved phase three and up to 2021, phase three deals, late stage deals. And it looks to me a little bit less face to face. One deals. Looking at later years, 2024, 2025, it looks like pharma.

01:20:31:21 - 01:20:37:16

Alasdair Milton

It starts to go a little bit earlier. Do we read this right? Is this really the shift that we see here.

01:20:37:18 - 01:20:56:09

Christian Soschner

Yeah I think for the most part definitely in 2024 we saw things go early. I mean you can see here that there were no there were no commercial stage deals by the top 20 pharma companies in 2024. We've kind of had a couple so far this year. We had a couple in 2023. I think it comes down to a few things.

01:20:56:09 - 01:21:18:18

Christian Soschner

I think, you know, first off, the higher volume of commercial stage deals in 22 and 23, that probably left just a relative scarcity of available kind of dearest assets. I think that probably drove up premiums for their target. Attractive targets that were actually left. And I think that means that, you know, acquirers might be a little bit worried about overpaying.

01:21:18:20 - 01:21:45:18

Christian Soschner

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 acquire has been 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 and their ability to access that innovation at a lower price versus when a company has more advanced assets.

01:21:45:18 - 01:22:12:10

Christian Soschner

And then you can do risk by building. And 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, you know, really cutting edge technologies like in vivo carts or RNA platform, those, very early, and, you know, we've seen multiple deals and in those areas in 2025, I think that backs up that that hypothesis.

01:22:12:10 - 01:22:30:00

Christian Soschner

So I think that's the kind of shift we're seeing. Let's see what 26 looks like. I certainly don't think that dealmaking for 25 is over and done with. I think we're heading into JP Morgan. It's going to be it's going to be pretty busy I think. So let's see how the rest of the year and the early part of 26, you know, plays

01:22:30:00 - 01:22:31:12

Christian Soschner

out.

01:22:31:14 - 01:22:51:08

Alasdair Milton

Yeah, I like the explanation. I think you mentioned all the important parts that you need for data platform good management. And when I look at your 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?

01:22:51:10 - 01:22:53:03

Christian Soschner

Yeah.

01:22:53:03 - 01:23:17:00

Christian Soschner

So look, I think from a therapeutic perspective, it's probably not surprising to a lot of folks. On her view in the podcast that oncology continues to get a lot of investment. Also neurology immunology and actually cardio metabolic. So 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 therapies.

01:23:17:00 - 01:23:38:18

Christian Soschner

I think oncology is I think, roughly half of all the deals. It's 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 lion's share of the deals. Neuroscience is having a resurgence is having a little bit of a moment.

01:23:38:20 - 01:24:07:19

Christian Soschner

We mentioned the JNJ intercellular deal at the start of the year. That's to date that's been the biggest deal so far. But there are, there is, there is the Lilly acquisition of a company called Site One for its pain portfolio. Cardio was interesting. We saw that kind of more kind of traditional deal with the Novartis acquisition of a company called Anthos for its blood thinner, but also in really the really cutting edge side of cardio.

01:24:07:21 - 01:24:32:05

Christian Soschner

There was the Lilly Verve deal for a gene editing technology for atherosclerosis, and then we're seeing companies obviously execute a lot of M&A and a lot of partnering in obesity. We're all familiar with the recent Pfizer novel Battle to Win. Sara. So, you know, metabolic is huge area right now. And then rare disease always again just is always there as well.

01:24:32:05 - 01:24:55:16

Christian Soschner

We're still seeing a lot of interest. So similar to oncology in rare disease you're very clear red pathways premium pricing and huge unmet need. And then on the technology side you know we talked about Invivo Car-T. What's interesting with that space is not just oncology. You know, it's auto immune. We're also seeing, investment in RNA therapeutics. And then technologies like, ADCs by specifics.

01:24:55:18 - 01:25:12:13

Christian Soschner

And then there was the recent Novartis a that deal for technology called an 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.

01:25:12:16 - 01:25:32:05

Alasdair Milton

Now 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 20 2021, it looked like everybody's investing in pharma, biotech and in biopharma no matter how early the deal is.

01:25:32:05 - 01:26:09:13

Alasdair Milton

And then the whole market collapsed. And it looked to me like everybody's pulling out and we see pharma, lifestyle activity, private equity. All the tourist investors just went back home 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, in the questionable, territory where it can go up and down?

01:26:09:13 - 01:26:12:13

Alasdair Milton

How do they act across the value chain today?

01:26:12:15 - 01:26:12:21

Christian Soschner

Yeah,

01:26:12:21 - 01:26:32:18

Christian Soschner

that's a really good question. I mean, there's a couple of factors I can call out. I think one stakeholder that's been stepping in recently a lot, 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.

01:26:32:20 - 01:26:58:17

Christian Soschner

I think they've been investing earlier in recent years. I think between the, between Novo, Sanofi and Lilly, they've invested 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.

01:26:58:19 - 01:27:27:22

Christian Soschner

It's a steady, 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 investor.

01:27:27:22 - 01:27:48:02

Christian Soschner

So I think it's a sign of validation for other investors. They know farmers. And they're they're looking at the signs. They like what they see. I think the downside to having corporate involved is you're tied to the strategic direction of that pharma company. And so if there's a change of strategic direction in direction of that company, that may mean that your sense is no longer a focus for them.

01:27:48:02 - 01:28:08:24

Christian Soschner

But 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 with R&D spending kind of slowing down and uncertainty around government funding for private equity, clients are really leaning into a lot of these clinical solutions.

01:28:08:24 - 01:28:41:24

Christian Soschner

They see clear opportunities. So as trials get more complex, especially in areas like oncology, biopharma companies are relying more and more on outsourced partners. And so the PE firms are investing heavily in those service providers to cross the CDMO as 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 now, while the macroeconomic picture is still a little bit shaky, those firms are largely looking past the noise.

01:28:41:24 - 01:29:09:12

Christian Soschner

The short term noise. And they're focusing on those longer term growth opportunities. Now what's really surprising is, is seeing Peg 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.

01:29:09:12 - 01:29:33:23

Christian Soschner

They have a risk sharing that they did with Sanofi for Sanofi's cancer drugs Barclays where they funded, you know, 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 on the on the, in the formulation for, for future sales.

01:29:33:23 - 01:29:54:13

Christian Soschner

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, ticker Gene Therapy Company called Bluebird Bio Private. I think Bluebird had amazing signs. They really struggled with the commercial side. It's relaunched as a company called genetics, and they're hoping to fix the manufacturing and the commercial execution.

01:29:54:13 - 01:30:13:19

Christian Soschner

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 science. That's what I call it, where we're seeing a couple of that. The actors playing at the moment.

01:30:14:20 - 01:30:36:10

Alasdair Milton

Do so a lot of positive sign. So pleasantly surprised when we, sidestep a little bit on on deal structuring until making, I know from my audience that, many scientists who start the company now come into this situation for the first time in their lives to do a deal. And what they do generally is going to a seminar and to learn, structuring a deal process.

01:30:36:12 - 01:31:07:11

Alasdair Milton

And in theory, it's the same 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 in the field. Good insights. What's your read on how biopharma companies today are approaching transactions in reality and not theory?

01:31:07:13 - 01:31:07:20

Christian Soschner

Yeah,

01:31:07:20 - 01:31:27:12

Christian Soschner

that's a good that's a good question. And you're right. Everyone is a little bit different. There are some commonalities here. Yeah. Every pharma companies go to 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 for best in class or first in class assets.

01:31:27:14 - 01:31:49:21

Christian Soschner

But even if you have first in class, if it's a really competitive environment, the pharma company, they want to see differentiation there, whether that's scientific or thinking about the patient population. So can you expand the addressable addressable population beyond the initial indication for best in class? I think it goes beyond just safe and efficacy. It's also things like pricing and convenience.

01:31:49:23 - 01:32:17:00

Christian Soschner

I do think it's really important for biotech companies to have, you know, 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, next value inflection point really quickly. And I think that can be a big mistake because of a feature pharma partner has to come in, sees things they don't like, and they potentially have to fix those issues.

01:32:17:00 - 01:32:40:21

Christian Soschner

So I think you have to have a very clear vision for your program as well, even if it's it's early stage. I think it's helpful for the pharma 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 you have to be able to very clearly articulate your thesis and your path to market, including your differentiation.

01:32:40:24 - 01:33:20:19

Christian Soschner

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, and I think especially for complex modalities by specifics, ADC selling 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 on manufacturing scale and so pharma companies are looking for very robust CMC plans, realistic timelines.

01:33:20:21 - 01:33:41:05

Christian Soschner

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, Christine, 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 Kovid Sugar High.

01:33:41:05 - 01:34:02:01

Christian Soschner

When we sell those companies for months that didn't have good signs, 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 yeah, 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.

01:34:02:01 - 01:34:32:19

Christian Soschner

And if you if you have clear clinical data that's fantastic. You got to have a well-articulated story that's going to be very well thought through, very methodical approach to your milestones and your future market. I think pharma partners are looking for, potential partners to 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?

01:34:33:05 - 01:34:52:07

Alasdair Milton

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 it wants to be an acquisition target. And, you mentioned all the important points, and this is so great to hear. From from your perspective, what it takes to move a company forward into acquisition mode.

01:34:52:09 - 01:35:17:00

Alasdair Milton

When I go back and forth, taking a lot of notes that I think it's interesting to explore a little bit further to what you said before. The overall situation on the market. But when I listened correctly and understood you. Right. We see the activity going up on the pharma side, but you mentioned also that, we see fewer IPOs or more acquisition, fewer IPOs.

01:35:17:02 - 01:35:28:24

Alasdair Milton

And in combination with that, less venture capital deployment, how how do you interpret this entire environment? When we look into the future?

01:35:29:01 - 01:35:29:13

Christian Soschner

Yeah.

01:35:29:13 - 01:35:52:12

Christian Soschner

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 early as something that's much, much tougher environment for biotech today. So, you know, in speaking with friends and clients and business development at pharma companies, big pharma companies, you know, a few years ago they couldn't get biotech interested.

01:35:52:12 - 01:36:16:11

Christian Soschner

The private and the public markets were booming. We had dozens of biotech IPO was the Exp 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 power. As we talked about, a little bit ago, biotechs are starved of cash.

01:36:16:13 - 01:36:39:24

Christian Soschner

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 going to 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.

01:36:40:01 - 01:37:00:02

Christian Soschner

So for me, you know, 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 pull on M&A.

01:37:00:02 - 01:37:05:11

Christian Soschner

So I think right now that swing is very much towards the pharma companies.

01:37:06:06 - 01:37:25:17

Alasdair Milton

Yeah, it looks like it looks like we covered the microeconomic side, how companies are built, what's happening on the market. And there was one point I'd 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 on the market. It's inflation.

01:37:25:22 - 01:37:45:06

Alasdair Milton

We have a different situation in the US and in Europe, interest rate changes that influence that. And you also mentioned geopolitics. That's 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.

01:37:45:08 - 01:37:46:14

Christian Soschner

That's critical. I mean

01:37:46:14 - 01:37:56:04

Christian Soschner

it's the policy and economic environment is is absolutely critical. You know, one of the biggest factors that we didn't really touch on is the, the Inflation

01:37:56:04 - 01:38:00:12

Christian Soschner

Reduction Act at school, the IRA here in the US, it's a real game changer. It allows the

01:38:00:12 - 01:38:09:23

Christian Soschner

US government to basically directly negotiate drug prices. The issue is it creates, a much shorter revenue window for small molecules.

01:38:09:23 - 01:38:32:03

Christian Soschner

There is certain provisions in the IRA 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 that it really pressures the companies to launch in larger markets. First, because you want to maximize your return before the price controls kick in.

01:38:32:05 - 01:38:54:04

Christian Soschner

That puts, drug development in areas like rare disease at a disadvantage. You know, we actually saw a noticeable drop in new clinical trial stocks right after the IRA was implemented. And that's just that's just one headwind. So the industry, you know, we're all familiar with the impact of the tariffs. We've got high interest rates. They are gradually coming down.

01:38:54:04 - 01:39:24:16

Christian Soschner

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've focused on M&A and 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 array acquisitions.

01:39:24:16 - 01:39:47:21

Christian Soschner

So there's a clear focus on assets that are already in clinical trials. Tapping into the 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 to focus, cut cost, 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 Spring Works.

01:39:47:21 - 01:40:08:04

Christian Soschner

A few years ago, it took Deprioritized assets out of of Pfizer, and that company was acquired for, I think, 3 or $4 billion earlier in 2025. So we saw similar success with cerebral. That was another Pfizer spin out that we bought for about 9 billion. So there are some great returns, which is why more companies are looking at this kind of strategy.

01:40:08:06 - 01:40:29:08

Christian Soschner

And then again, just earlier this year, BMS spun off some auto immune drugs with the backing from Bain. So, yeah, the macro environment has a huge impact on 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.

01:40:29:08 - 01:40:32:24

Christian Soschner

So hopefully that answers your question.

01:40:33:01 - 01:40:34:00

Alasdair Milton

Yes, absolutely.

01:40:34:00 - 01:40:55:17

Christian Soschner

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

01:40:55:19 - 01:40:56:03

Alasdair Milton

I don't

01:40:56:03 - 01:41:20:01

Alasdair Milton

think it's a blip. I still don't think that private equity is necessarily going to be investing in early stage drug development any time 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.

01:41:20:01 - 01:41:30:18

Alasdair Milton

And so for PE, there's a lot of activity there. But picking up, different players on the clinical research and the CDMO space, I think the Bain and Carlyle funds

01:41:30:18 - 01:41:41:20

Alasdair Milton

are a little bit different. I mean, I think, Carlyle actually took private a gene therapy company called Bluebird. That wasn't doing so well. And,

01:41:41:20 - 01:41:43:20

Alasdair Milton

it had some commercial challenges.

01:41:43:20 - 01:42:06:10

Alasdair Milton

And so the it was a take private, they just, relaunched the company. And so they're going to 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, we're we'll see a lot of PE investing like, I don't I don't expect PE to do a traditional biopharma pre-clinical phase one investing.

01:42:06:12 - 01:42:20:10

Alasdair Milton

There have been those examples of that historically, for example, where there definitely put in capital into drug development in return for future royalties and sales. But a lot of the activity we see is around the pharma services ecosystem.

01:42:20:10 - 01:42:21:04

Christian Soschner

So

01:42:21:04 - 01:42:41:24

Christian Soschner

yeah, it's good to have more money flowing into this area. It means, that, people can do more. So it's always a good sign that their activity is probably coming back. And we have seen the worst in the past and looking more towards a brighter future. Yep. But if we look at the challenges, it's not only in, locally in the US, but, there's also a global shift.

01:42:42:03 - 01:42:50:02

Christian Soschner

China, India, new players are emerging. How do you see the world changing, regional wise?

01:42:50:04 - 01:42:50:15

Alasdair Milton

Yeah.

01:42:50:15 - 01:42:53:07

Alasdair Milton

Do you mind if I, pull up another slide or two?

01:42:53:09 - 01:42:54:16

Christian Soschner

You're welcome.

01:42:54:18 - 01:42:58:12

Alasdair Milton

Okay, hold on a second. Let's, let's talk a little bit about

01:42:58:12 - 01:43:20:02

Alasdair Milton

China and India. So, so to me, what we've got here is, a slide that shows, the pipeline data base for monoclonal antibodies. So it shows the number of monoclonal antibodies in each year of the pipeline, the global pipeline from 2015 to 2025.

01:43:20:04 - 01:43:43:13

Alasdair Milton

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 could think of as truly innovative assets? No, no they're not. Most of them are probably me to me.

01:43:43:13 - 01:44:09:01

Alasdair Milton

Better. But it just goes to show how fast the Chinese have caught up. I was in China 7 or 8 years ago. I was doing some work. The private firm that I was at, and it was for an advocacy group, for a 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.

01:44:09:03 - 01:44:28:01

Alasdair Milton

And we talked about the fact that, you know, the number of jobs it attracts and the limit of investment. And you fast forward to 7 or 8 years later. And that's the really impressive thing about China. To me, it's the speed with which they've caught up so, well, India, I think it's kind of stood still since I was back in 2018 has evolved a little bit.

01:44:28:01 - 01:44:54:12

Alasdair Milton

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, you know, one third of the monoclonal pipeline now coming from China is absolutely incredible.

01:44:54:14 - 01:45:19:06

Alasdair Milton

If I just kind of flick forward one other slide, this is showing the dual trends between 2014 and 2024. In China, the blue bar shows the number of licensing deals done from China. And this is not just US companies. It's it's it's any company outside of China. So this is all licensing deals done. And from China. And the light blue bar shows the dollar value of those deals.

01:45:19:08 - 01:45:43:18

Alasdair Milton

And I think in the first half of 25 there was 60 or deals worth about 50 billion. And so you can see that 2025 is going to far exceed 2024. I still think, you know, people say is the US going to lose its innovation crown? I still think that the basic foundational science here in the US is still the leader.

01:45:43:20 - 01:46:05:13

Alasdair Milton

I don't think that's going to 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 are so intense, it forces everyone to be very, very efficient. And the proof is in the deals, right?

01:46:05:15 - 01:46:30:01

Alasdair Milton

Big Pharma in from the West, from the US and Europe. They're 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. I mean, by the 2030s, I wouldn't be surprised if a significant chunk of the world's truly innovative molecules are coming from China.

01:46:30:03 - 01:46:34:04

Alasdair Milton

And they're aggressively trying to catch up with the US.

01:46:34:17 - 01:46:42:24

Christian Soschner

Let me go back. One slide. Yeah, I found this, this is quite interesting when you look at, the percentages in

01:46:42:24 - 01:47:02:05

Christian Soschner

the US, that didn't change pretty much. So we see 2015 about 50% ish, participation of the US. And to 2025, it's pretty much the same. China just skyrockets from 6%, almost nothing. Basically, in this space monoclonal antibody, almost nothing non-existent.

01:47:02:07 - 01:47:31:06

Christian Soschner

And then 32% ten years later. And the rest of the world, which I assume is pretty much Europe. Yep. It's going from 40% down to 20%. This is a completely shift in the industry, completely eastward. And as I said, when you played for about ten years in the future, if this continues and if they keep investing in this space, it's will become more and more important.

01:47:31:08 - 01:47:31:22

Alasdair Milton

Yeah. And

01:47:31:22 - 01:47:57:06

Alasdair Milton

like I see a lot of these molecules are follow on molecules. It's not truly innovative I think. But the Chinese are really good at 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 1 or 2 examples, but again, it's, they are determined to catch up.

01:47:57:06 - 01:48:17:02

Alasdair Milton

And if it continues this way, then then if we keep chipping away at the innovation current 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.

01:48:17:04 - 01:48:26:19

Christian Soschner

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

01:48:26:21 - 01:48:56:11

Alasdair Milton

Yeah, I think but 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 ahead and biotech, they created policies that made it easier to get funding to get drugs approved faster. They created a lot of local, parks. And 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.

01:48:56:13 - 01:49:16:06

Alasdair Milton

I think one of the real tailwinds was when they joined the, the International Council for harmonization in 2017. So that's when they basically kind of plugged into the the they plugged the regulatory system into the rest of the world. And so that that was a huge signal that they were going to play with the same rules.

01:49:16:08 - 01:49:35:11

Alasdair Milton

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, the pharmaceutical Inspection Cooperation scheme is a little bit of a mouthful, but that's a little bit global manufacturing quality standards. And so it's just another piece of evidence that they're not really cutting corners.

01:49:35:11 - 01:49:53:02

Alasdair Milton

They're 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 VC ecosystem as well. You know, I think when it comes to the deals, you know, and there are some watch outs as well on China, it all comes down to the data.

01:49:53:04 - 01:50:17:17

Alasdair Milton

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 can be rapidly replicated in other populations. And so there are risks. And watch outs from China as well. But they're they're thinking about this in, in terms of licensing all of these assets, getting their feet wet with international deals with the Western companies.

01:50:17:17 - 01:50:39:11

Alasdair Milton

And so it's all about early partnerships, figuring out how the global markets work, you know, what kind of operating models they need and how those deals fit into their longer term strategy. And so those initial deals for the, Western companies are basically for for these Chinese biotechs. It's about almost like a practice run that helps to build the experience base.

01:50:39:23 - 01:51:05:01

Alasdair Milton

So quite often they'll hold the Chinese rights to these assets, the license. So the rest of world deals. And so it's just it's but again, I come back to the speed, and, and just how fast they've moved, it's just absolutely incredible. And one one thing that's worth noting that will do is quite smart is, to kind of get around some of the geopolitical dynamics and to to speed things up a little bit.

01:51:05:03 - 01:51:15:21

Alasdair Milton

And they'll set up a new course so they'll make spin off some of their assets into a US company, gets Western VCs to fund it. And I think that's a smart way to get global traction as well. And

01:51:15:21 - 01:51:20:12

Alasdair Milton

hopefully reduce some of that. That geopolitical risk.

01:51:20:14 - 01:51:48:09

Christian Soschner

Yeah I hope we we I hope for the best. But it means actually with all this, 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 to develop, what to bring to the market, how they can license that.

01:51:48:11 - 01:52:08:05

Christian Soschner

And you have experience in, in both regions. You've worked we grew up in Europe. You worked in the United States and also worked a lot with China. And you mentioned that there are some risks and watch out for Western firms. What are these walkouts that Western firms should take care of when they think about working with Chinese companies?

01:52:08:07 - 01:52:30:17

Alasdair Milton

Yeah, like I see I think, a lot of it is that is that is the data. And, you know, you 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 gotta have people in the country who can meet with local scientists, meet with local business leaders to really get diligence up front.

01:52:30:19 - 01:52:49:10

Alasdair Milton

And that's why, you know, again, we've got a really incredible China team here in 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 and perspective, but it's nothing like having somebody who's Chinese, who speaks the language and who knows the culture and who's on the ground.

01:52:49:12 - 01:53:10:19

Alasdair Milton

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 can 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, that I think that's absolutely critical for success.

01:53:12:24 - 01:53:38:24

Christian Soschner

I mean, 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 there are also, looking to what's evolving their part. As you mentioned before, we have a lot of investments in that area. How do you see prices, precision medicine in China?

01:53:39:01 - 01:53:39:06

Alasdair Milton

Yeah,

01:53:39:06 - 01:54:03:14

Alasdair Milton

that's a great question. I think 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.

01:54:03:16 - 01:54:31:10

Alasdair Milton

If you think about cancer, for example, I think China's no. I think it's roughly 1 in 4 of all cancer cases globally. So makes it a really perfect place to kind of develop and test 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.

01:54:31:10 - 01:54:56:10

Alasdair Milton

Just because of the sheer, the sheer scale. And so that actually has an effect on the composition of the drug pipeline as well. I mean, we didn't talk about this earlier, about the molecules coming from China. Yes. Probably me to me better, but they are towards the more cutting edge of antibody drug conjugates by specific antibodies selling gene therapies.

01:54:56:12 - 01:55:25:19

Alasdair Milton

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, for precision medicine. Are there of course, reimbursement challenges. Yes. It's the same in any market. But I think the sheer, the sheer size of that population really makes it a great place for testing those therapies, testing those, those diagnostics.

01:55:26:07 - 01:55:28:03

Christian Soschner

And the speed strength that comes with that.

01:55:28:05 - 01:55:30:00

Alasdair Milton

And this piece, exactly like

01:55:30:00 - 01:56:09:10

Alasdair Milton

you said, the speed in their ability to move fast. Yeah. They're I've known some there was, an asset, company called I think it was Cygnet had produced and it's, it's a mix of like an organoid. And I so it's, I think it's coming out of a company called Cygnet, and it's, I think they're in Shenzhen, which I think is it's in the region of China, which is basically their Silicon Valley, their tech hub, and this assets for diffuse gastric cancer.

01:56:09:12 - 01:56:32:07

Alasdair Milton

Like I see it, it's a combination of organoid models. And I. 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.

01:56:32:09 - 01:56:56:17

Alasdair Milton

But it was the speed. It was just astonishing. It went from discovery to, I think it was AI. And within just a couple of years, it's a couple of years incredibly fast. And now it's in phase one studies in China. And 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.

01:56:56:17 - 01:57:02:18

Alasdair Milton

So again, that speed that they're able to move out is is really quite incredible.

01:57:03:13 - 01:57:28:19

Christian Soschner

You mentioned huge size. I always think about real diseases and China's these huge cities. So I guess for trade China must be in reality is is really a good place to do studies when they can really pull from the entire population, homogenous population patients into that studies. And this is my explanation for why why they can move so fast.

01:57:28:21 - 01:57:30:12

Alasdair Milton

Yeah.

01:57:30:14 - 01:57:40:24

Christian Soschner

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

01:57:41:01 - 01:57:42:10

Alasdair Milton

I think

01:57:42:10 - 01:58:16:06

Alasdair Milton

that story around stigma is what really blew my mind. It 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.

01:58:16:06 - 01:58:18:02

Alasdair Milton

Is that you had this Chinese company that

01:58:18:02 - 01:58:24:16

Alasdair Milton

developed this first ever drug using AI and organoids, and it was now in humans, within a couple of years of just the

01:58:24:16 - 01:58:43:13

Alasdair Milton

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 to be better, and it wasn't truly innovative stuff, but there's a perfect example of of true innovation there.

01:58:43:15 - 01:59:05:24

Alasdair Milton

So that that to me was 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. The the focus, the drive of the Chinese to be at the forefront of biomedical innovation

01:59:05:24 - 01:59:07:15

Alasdair Milton

and development.

01:59:07:15 - 01:59:34:22

Christian Soschner

You had the 90s basically Europe and the United States. Janet 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 with some time was, its own market Chinese already there. Where do you see India play a role in the next ten years?

01:59:34:24 - 01:59:36:01

Alasdair Milton

Yeah. That's a

01:59:36:01 - 01:59:50:02

Alasdair Milton

that's a great question. So like I said, I was there eight or 7 or 8 years ago with the advocacy group and, and India has kind of stayed still and China has just accelerated. I think India's role in the

01:59:50:02 - 01:59:58:06

Alasdair Milton

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.

01:59:58:08 - 02:00:26:19

Alasdair Milton

The plan a little bit of a different game, kind of focusing on what they do best. So making things affordable at huge scale and and innovating in different ways. So we've obviously seen there they're 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 new stories actually move into kind of original R&D.

02:00:26:21 - 02:00:50:08

Alasdair Milton

You're starting to see very early days, but you are starting to see some really cool, stuff in oncology and cell therapy. Companies like Buy Kare and Origin. You know, 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.

02:00:50:10 - 02:01:18:10

Alasdair Milton

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, you know, India could become a pretty major source of, of, of cost effective innovation. The challenge, though, unlike the Chinese, is that it's not a one party system. I think a big part of the Chinese success story is because of the Communist Party and because they're able to just

02:01:18:10 - 02:01:21:14

Alasdair Milton

say, we are going to do this, and that's it.

02:01:21:14 - 02:01:30:00

Alasdair Milton

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

02:01:30:00 - 02:01:43:09

Alasdair Milton

dynamic is a little bit different. There. And so that that could be something that holds them back a little bit. But they're, they're definitely evolving, as well. Just not at the same, the same rapid pace as the Chinese

02:01:43:09 - 02:01:43:19

Alasdair Milton

do.

02:01:43:20 - 02:02:11:20

Christian Soschner

I think India is 1.2 billion something people. So it's pretty huge and, democratic system for the patient. And I'm optimistic. I mean, when we look at the chart again, and I have the picture in the mind from, two continents system. Now with China, Asia is emerging. India. Then we have basically half the world's working for the patients in the future together on solving, our medical challenges.

02:02:11:22 - 02:02:13:13

Christian Soschner

It's pretty. Yeah. Mystic.

02:02:13:15 - 02:02:17:22

Alasdair Milton

Yeah. It is. It's good. I think that the continent is missing it. There's obviously Africa.

02:02:17:24 - 02:02:18:06

Christian Soschner

Yeah.

02:02:18:11 - 02:02:19:24

Alasdair Milton

How so?

02:02:19:24 - 02:02:21:07

Alasdair Milton

We don't we don't see.

02:02:21:07 - 02:02:38:12

Alasdair Milton

We don't see enough investment in Africa. I think it's still, you know, so let's say a lot of to you, there's obviously a lot of political tensions, 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.

02:02:38:12 - 02:02:52:22

Alasdair Milton

So but I'd love to see more effort in, into, into Africa, for, for truly innovative medicines rather than just, you know, vaccines and, you know, anti-infective and stuff like that.

02:02:53:10 - 02:02:58:19

Christian Soschner

Since you mentioned that. Okay. I'm also curious, how is your perspective from Latin America?

02:02:58:21 - 02:03:00:06

Alasdair Milton

Yeah, that's a

02:03:00:06 - 02:03:12:06

Alasdair Milton

yeah. Good question. So again, I, we, we see Latin America like it's, one area, right. Yeah. Yeah. You know, every, every country there's so different. Brazil

02:03:12:06 - 02:03:25:22

Alasdair Milton

has some of the most advanced diagnostic technologies and diagnostic labs, and cutting edge labs in, in the world. And so I think, again, you have to think of these countries in different ways.

02:03:25:22 - 02:03:49:18

Alasdair Milton

And Brazil is, 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. You know, obviously, a lot of these countries and a lot of political turmoil and budgets are very, very tight.

02:03:49:18 - 02:04:01:00

Alasdair Milton

And, you know, we've had catastrophic social issues in countries like Venezuela and Argentina. And so the the highest priority for government is always health care. But,

02:04:01:00 - 02:04:13:03

Alasdair Milton

but I think that that can be that is the key thing is, is the government really investing and stepping in? We just haven't seen it a lot unfortunately. But Brazil is definitely the standard.

02:04:13:05 - 02:04:28:16

Christian Soschner

When you try to look for the optimistic lens. And you mentioned that all this, this confidence that we talked about working together for the patient, even just imagine what we can achieve, what, leaps we can make an innovation into pharma industry.

02:04:28:18 - 02:04:29:16

Alasdair Milton

Yeah, I, I

02:04:29:16 - 02:04:41:20

Alasdair Milton

agree, I agree. I think, unfortunately their health healthcare isn't always top of the, the list for a lot of these governments. But hopefully that will change.

02:04:42:07 - 02:05:01:00

Christian Soschner

Yeah, we will say 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 this, the future of medicine. Why are you so optimistic about this area?

02:05:01:02 - 02:05:02:22

Alasdair Milton

Yeah. So so

02:05:02:22 - 02:05:20:07

Alasdair Milton

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. I mean, it's a it's a muscle. We've, we've, we've been building for a number of years.

02:05:20:09 - 02:05:45:18

Alasdair Milton

Again, you know, coming from a PhD in cancer biology, a lot of the leaders here in KPMG have 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 and is a real double click area. And we don't just think of precision medicine and say, EGFR testing and lung cancer.

02:05:45:20 - 02:06:11:04

Alasdair Milton

I think of precision medicine as how can I take data, right? How can I take data with Christian or take data the A-lister and tailor an intervention to you as an individual based on that data. And 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.

02:06:11:06 - 02:06:33:00

Alasdair Milton

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 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.

02:06:33:00 - 02:07:00:18

Alasdair Milton

We've been in precision medicine in oncology for decades. We actually still don't get it right. We still don't get that 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 here showing some cognitive impairment.

02:07:00:20 - 02:07:25:08

Alasdair Milton

You know, it's a huge deal. We can move away from relying woefully on costly and invasive Pet scans. It starts to change the narrative about diseases like Alzheimer's through 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.

02:07:25:08 - 02:07:47:05

Alasdair Milton

We've used to just think of them as though Parkinson's or epilepsy. It was a 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 mechanisms, and not just by the clinical. And then another area that we're seeing a lot of focus in is women's health.

02:07:47:07 - 02:08:14:17

Alasdair Milton

You know, that's seeing a major structural shift. Diagnostics is really the foundation of all we're seeing a lot of innovation and funding pouring into women's health. You know, the labs are becoming faster and more personalized care. We're seeing innovators making really big strides in areas like menopause, fertility solutions. And then overall, I think we're we're in a we're basically in a post genomics era in precision medicine.

02:08:14:17 - 02:08:36:10

Alasdair Milton

So it's now about proteomics. It's about single cell analysis sits around spatial biology. And we're seeing a lot of deal activity around that as well. So thermo bought a company called All Inc last year for about 3 billion, to get their hands in the proteomic capabilities of all link. Illumina acquired Sumo Logic earlier this year for for something similar.

02:08:36:10 - 02:09:09:01

Alasdair Milton

So you know, 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 saw any investment. We're now seeing a lot more focus. So I'm you can tell my my in my scientific hat on I get super excited about this space.

02:09:09:01 - 02:09:23:13

Alasdair Milton

But I think it's a game changer because if we can, if we can, really harness the power of precision medicine, we can ensure better outcomes for patients and lower cost to the health care system.

02:09:24:13 - 02:09:45:12

Christian Soschner

It seems to spread in every area. I mean, 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 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.

02:09:45:12 - 02:09:50:05

Christian Soschner

And then the industry that's coming can we set it this way?

02:09:50:07 - 02:09:50:16

Alasdair Milton

Yeah, I

02:09:50:16 - 02:10:31:05

Alasdair Milton

think so. I mean, there's still systemic challenges. So I think especially in the US, the system no health care system was designed for precision medicine. The health care 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 the money, the discovery, the manufacturing, the delivery of precision medicines, the partnerships that have to happen between pharma companies and diagnostic companies, the labs with the tests are run the the obviously the emergence of AI and precision medicine generates just such a huge amount of information on individuals.

02:10:31:07 - 02:10:48:23

Alasdair Milton

So having that technology of AI being 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 5 to 10 years, we can start to close some of those gaps.

02:10:49:06 - 02:11:13:17

Christian Soschner

But this also means more to 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 for many other industries, when we see such a paradigm shift. Let's move to the next question. If you could redesign one part of the health care system to fit for precision medicine.

02:11:13:19 - 02:11:19:09

Christian Soschner

But there what to start.

02:11:19:11 - 02:11:20:13

Alasdair Milton

I think I'll

02:11:20:13 - 02:11:37:21

Alasdair Milton

talk about the US first. Because that's obviously my home market. I, I think it would have to be about the data. I mean, 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.

02:11:38:02 - 02:12:03:18

Alasdair Milton

So, the health care system here is, is so fragmented. So trying to share patient information between different places is a real problem. It makes it hard to follow somebody longitudinally through the system. And on top of that, everyone is using their own systems. There's no common way to talk about the data. And to be quite honest, the quality of the data between institutions can be very different.

02:12:03:20 - 02:12:29:08

Alasdair Milton

We are seeing some new systems being developed which allow the 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 so we're starting to see, new systems like that.

02:12:29:08 - 02:12:53:06

Alasdair Milton

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 up 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.

02:12:53:08 - 02:13:18:10

Alasdair Milton

We need to teach physicians and all healthcare practitioners and all health care workers more generally to 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, with, the system, a lofty goal, but hopefully one that we can achieve one day.

02:13:19:11 - 02:13:26:14

Christian Soschner

So when industry writes, data is becoming more and more important. That's the basic idea of precision medicine.

02:13:26:16 - 02:13:29:01

Alasdair Milton

Yeah. Yeah. Exactly. And

02:13:29:01 - 02:13:52:03

Alasdair Milton

there's a huge amount of it. I mean it could be like I say it could be genomic information. And I talked about the post genomic era where we're starting to think about what's the interplay with proteomics, with metabolomics, transcriptomics, you know, that that whole omics system, that biology part. But also, your environment, right, your environment plays, it plays a role or your lifestyle, what you eat.

02:13:52:05 - 02:14:03:20

Alasdair Milton

You know, 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 for the patient.

02:14:03:22 - 02:14:10:21

Christian Soschner

To be captured. Without that, you mentioned artificial intelligence. What role do you see play? Is it playing in precision medicine?

02:14:10:23 - 02:14:11:07

Alasdair Milton

Yeah. Let

02:14:11:07 - 02:14:21:06

Alasdair Milton

me I'm going to go back in, bring up another slide here. Just to give you some examples of, of how we're seeing AI

02:14:21:06 - 02:14:25:14

Alasdair Milton

in precision medicine. Can you see that? Okay.

02:14:25:16 - 02:14:26:24

Christian Soschner

Yeah. Perfect.

02:14:27:01 - 02:14:49:18

Alasdair Milton

So 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 then on to 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 rest of a risk of breast cancer.

02:14:49:18 - 02:15:25:06

Alasdair Milton

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. Can I use case? And the claims 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, pretty incredible if you think about screening to move over to the next part of the the next Chevron, you know, finding a disease, amongst otherwise, you know, very healthy individuals.

02:15:25:06 - 02:15:49:00

Alasdair Milton

That's really the holy grail. You have to balance the sensitivity and specificity, which is critical. So the chance of false positive or false false negative, there's companies like, like Delphi 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.

02:15:49:02 - 02:16:19:19

Alasdair Milton

There's companies developing AI algorithms to confirm diagnosis. We're seeing, a lot of the use of the technology as being complementary to, to digital pathology. So you can create digital versions of pathology slides and then overlay an AI algorithm that's got much better than the human identifying cancer. And then from the prognosis piece, you know, it has been used to ensure that some cancer patients, like prostate patients, the only receive hormonal therapy, when they're actually going to need it.

02:16:19:21 - 02:16:43:01

Alasdair Milton

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? You know, 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.

02:16:43:03 - 02:17:06:19

Alasdair Milton

And so we can use AI to leverage, you know, multiple markers, look at Pd-l1 staining in addition to something like CD8 positivity to really try and predict response. And then on finally in the monitoring piece, looking at recurrence as well. So similar to screening applications, you know, making sure you're accounting for the sensitivity and specificity levels.

02:17:06:21 - 02:17:39:07

Alasdair Milton

But companies are using AI to, to, to better monitor for recurrence through what we call mid 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, the different, genetic markers the patient might have.

02:17:39:09 - 02:17:52:19

Alasdair Milton

So we're optimizing the clinical trials. And 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.

02:17:54:01 - 02:18:00:06

Christian Soschner

As I said, the amazing times when we then it's, come to the next part, the vision for

02:18:00:06 - 02:18:18:05

Christian Soschner

biopharma in the future when you also imagine all these gadgets that we have these days that take data like, smartwatches, smartphones, your, your phones, glasses, adverts that, now companies work, to put artificial intelligence in cases and you can then track the eye movements.

02:18:18:10 - 02:18:31:16

Christian Soschner

I mean, this must be heaven for diagnostics and also for drug development, especially gene therapy. When do you see this really coming that we can bring over time this all together in future?

02:18:31:18 - 02:18:31:24

Alasdair Milton

I mean,

02:18:31:24 - 02:18:52:07

Alasdair Milton

the optimist in me says, yes, I think we have to. We have to be. Right. I mean, that's what we're all aiming for. But there are just systemic challenges, around around delivering care. Let me let me go back up one and I'll pull up one last slide, which I think, hopefully.

02:18:52:15 - 02:19:21:00

Alasdair Milton

Hopefully. You know, kind of lays bare the challenges that we face, unfortunately. So this is a slide, that it shows is published data here. You can see 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.

02:19:21:02 - 02:19:34:08

Alasdair Milton

If you took a thousand of them, who should get a targeted therapy right at that thousand on the far left, how many actually get that therapy? And it's only around a third. Now, bearing in mind that

02:19:34:08 - 02:19:41:19

Alasdair Milton

we've been doing precision medicine and long lung cancer for decades, over two decades, and we're still not getting it right.

02:19:41:19 - 02:19:42:20

Alasdair Milton

Okay.

02:19:42:20 - 02:20:06:19

Alasdair Milton

So we we see drop offs of patients because perhaps the right test wasn't ordered. So maybe the physician orders, PCR tests and they should order earnings 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.

02:20:06:21 - 02:20:34:08

Alasdair Milton

We go through these, you know, these multiple steps here where by this analysis, anyway, only a third of of advanced non-small cell lung cancer patients who should get targeted therapy actually get one. Now, again, this dynamic is probably not happening to the same extent in large academic medical centers like the Farber, like MSK, like city of Hope.

02:20:34:08 - 02:20:59:12

Alasdair Milton

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 oncologist who maybe sees two head and neck, four breast, three long every day. And so they're just trying to get through their day and, and, and testing, testing in the right way.

02:20:59:14 - 02:21:20:23

Alasdair Milton

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, you know, for those physicians who are in the clinic, they just need to know for this patient with these symptoms, what tests do I order and what do I do with the result?

02:21:21:04 - 02:21:58:21

Alasdair Milton

Right. What's the translation of that result? If they have a report that comes back and says variance of unknown significance, what does that mean for them? And so that's the challenge. And so well, I get so excited about all of the science, all the things we've talked about, all the opportunities selling gene therapy, targeted therapies. I, you know, 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.

02:21:58:23 - 02:22:03:06

Alasdair Milton

This is unfortunately what we see. So

02:22:03:06 - 02:22:11:11

Alasdair Milton

a little bit sobering, but so we're always hopeful that we can solve these challenges.

02:22:11:13 - 02:22:12:12

Christian Soschner

And so we have,

02:22:12:12 - 02:22:16:05

Christian Soschner

great patients, great possibilities, but

02:22:16:05 - 02:22:25:05

Christian Soschner

virtually reality that we have right now. And so it's one problem after the other to get there at the end of the day. So when I imagine that

02:22:25:05 - 02:22:44:11

Christian Soschner

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 toward.

02:22:44:12 - 02:22:52:01

Christian Soschner

So we think all these problems. Yeah. What would this goal be?

02:22:52:03 - 02:23:03:08

Alasdair Milton

Can, just one, let let me let me give you I'll give you a short answer and I'll give you two answers. Now, the first one is really short. The second one is a

02:23:03:08 - 02:23:16:23

Alasdair Milton

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 in the R&D, portfolio discussions.

02:23:17:00 - 02:23:37:19

Alasdair Milton

There's a lot of great science that goes on on the four walls, on these pharma companies, and it never sees the light of day. And we're seeing more companies externally to these, these deprioritized assets. There was an example earlier this year of BMS doing a deal with Bain Capital. So again, PE company externalize a lot of that science.

02:23:37:21 - 02:23:59:19

Alasdair Milton

That would be my one. 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 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 being more proactive.

02:23:59:21 - 02:24:15:10

Alasdair Milton

So we've been a sickness industry, right? We've treated disease, chronic disease. But can we move more towards lifelong wellness and, and, and kind of preemptive health. So

02:24:15:10 - 02:24:27:05

Alasdair Milton

instead of selling drugs to treat conditions once they appear, we I think we need to be working harder as an ecosystem to predict disease risk years out

02:24:27:05 - 02:24:35:06

Alasdair Milton

and and developing interventions that help to reverse things like cell damage before it becomes a diagnosed illness.

02:24:35:08 - 02:24:37:14

Alasdair Milton

And I think that puts the patient at the center of

02:24:37:14 - 02:24:58:08

Alasdair Milton

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, that's inherently just more personal. You know, it requires a continuous understanding of someone's biology, their lifestyle, their environment. You know, you'd have

02:24:58:08 - 02:25:09:07

Alasdair Milton

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.

02:25:09:09 - 02:25:33:20

Alasdair Milton

And to be honest, I think we we need this approach. We all know the health care 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, you know, our biopharma companies are our life science companies, for the most part, are for profit.

02:25:33:22 - 02:25:57:02

Alasdair Milton

And they need to meet the 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.

02:25:57:02 - 02:26:08:04

Alasdair Milton

But I think that would be, for me, the thing I would try and change about the industry over the next, you know, the next decade. I think that the current business model, I'm not sure is an entirely sustainable,

02:26:08:04 - 02:26:09:04

Alasdair Milton

not great.

02:26:09:05 - 02:26:34:16

Christian Soschner

It's great ideas. And I think for the first time in human history, we have also the tools and the means to do that. We didn't think the past was probably more, restrictive in in the available tools. Now with AI, with all this, capturing tools, data capturing tools you mentioned that really interest in point. Maybe we'll dive a little bit deeper into that, incentivize the big companies to externalize their data.

02:26:34:18 - 02:26:56:05

Christian Soschner

At the end of the day, it sounded to me you were talking about especially data of trials that failed, or when companies make a strategic decision and say we don't move forward, into that direction. So they just scrap the whole path 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's for us.

02:26:56:05 - 02:27:02:12

Christian Soschner

It's it does not have any value added to understand you write in such parts that you mean this part of this data.

02:27:02:20 - 02:27:22:24

Alasdair Milton

Yeah. No, it's it's sure it's the data, but it's the data tied to the asset. So it means that, you know, every quarter, every pharma company goes through a portfolio exercise where they say, what are we going to fund or what we're not going to fund. And the drugs that don't get funded, they go on the shelf and that IP expires and that drug is is not commercially viable.

02:27:22:24 - 02:27:27:18

Alasdair Milton

And they sometimes they'll try and externalize it. Sometimes they'll give it to, patient groups.

02:27:27:18 - 02:27:46:05

Alasdair Milton

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.

02:27:46:05 - 02:27:59:13

Alasdair Milton

So, I worked on a project in 2017, with a prior firm where we took deprioritized assets from Pfizer and we spun into a company called Spring Works.

02:27:59:13 - 02:28:06:21

Alasdair Milton

And Spring Works was subsequently sold to Merck KGaA. So chairman Merck earlier this year for

02:28:06:21 - 02:28:16:03

Alasdair Milton

about $4 billion. And Pfizer had some upside there. And similarly, Pfizer did something very similar not long after the spring Works deal.

02:28:16:03 - 02:28:44:11

Alasdair Milton

They took, neurological assets that they deprioritized and spun it into a company called Cerebro. And now BMS has just done it with some, Dos and immunology immunological assets in that partnership with being. 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.

02:28:44:11 - 02:28:56:13

Alasdair Milton

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 it's just, I just, I just know

02:28:56:13 - 02:29:02:22

Alasdair Milton

there's great science that never sees the light of day because it's killed in a quarterly portfolio review.

02:29:03:02 - 02:29:18:16

Christian Soschner

To me, it sounds always when I listen to you that, 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?

02:29:18:18 - 02:29:19:02

Alasdair Milton

Yeah,

02:29:19:02 - 02:29:33:06

Alasdair Milton

it's a good question. I think what I would say is, when I look at the stories of both Spring Works and Sierra Vale, that should be an incentive for pharma. I mean, Sierra will sold to AbbVie, I think for the $9 billion.

02:29:33:06 - 02:29:37:09

Alasdair Milton

Well and spring Merck over 4 billion.

02:29:37:09 - 02:29:46:22

Alasdair Milton

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.

02:29:46:24 - 02:30:08:14

Alasdair Milton

So and that to me is mean pharma right now is grappling with the challenges of how do we free up capital to reinvest in the pipeline. I mean, how can we get creative with, you know, 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.

02:30:08:16 - 02:30:22:11

Alasdair Milton

If you were to externalize it and you're you can get that revenue stream further down. You can redeploy that into the pipeline. So I think that would be, be I think those two examples are great examples of how that model can work.

02:30:22:18 - 02:30:35:15

Christian Soschner

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

02:30:35:17 - 02:30:41:22

Alasdair Milton

Yep. Exactly. But also I think, and supporting the ecosystem, obviously, but also I think

02:30:41:22 - 02:31:03:15

Alasdair Milton

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 be seen, can be seen to be doing better for patients as well.

02:31:03:15 - 02:31:30:02

Christian Soschner

Yeah, I totally agree. Totally agree. You have a long career, a very interesting career. From Scotland to the United States, from lab bench 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

02:31:30:02 - 02:31:41:17

Christian Soschner

move not only into life science and biopharma, but as I say, I would like to also understand the business aspect by saying, what advice would you give to the younger generation, now in their early 20s?

02:31:41:23 - 02:31:45:05

Christian Soschner

How should they approach this?

02:31:45:07 - 02:31:45:17

Alasdair Milton

So,

02:31:45:17 - 02:32:08:14

Alasdair Milton

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 we talked about this before, or to an investor in terms of risk. In return, you have to be able to build the bridge between the lab and the business world.

02:32:08:14 - 02:32:30:10

Alasdair Milton

And that's an invaluable skill. I said before that scientists tend to get knee deep in the detail, and that's great, but you have to be able to bring up a level to someone that's understandable to to business executives. So and and spend time learning about the industry, you don't have to do another degree, you know, listen to podcasts like this, read books, take online courses, you know, connect with people in the industry.

02:32:30:10 - 02:32:49:04

Alasdair Milton

I'm always happy to connect with people and share my experience and my perspectives, trying to, you know, carve out time for them to learn, you know, 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 then you'll make it happen.

02:32:49:04 - 02:33:14:18

Alasdair Milton

But, yeah, 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.

02:33:14:20 - 02:33:26:13

Alasdair Milton

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.

02:33:26:21 - 02:33:38:05

Christian Soschner

Yeah. Totally agree. And when we look at your team, how do you see your team impacting the industry and society in the coming ten years? What goes through your personal.

02:33:38:07 - 02:33:38:22

Alasdair Milton

What goals

02:33:38:22 - 02:34:22:18

Alasdair Milton

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. You know, the, the example I gave earlier of Spring Works been able to 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, you know, really helping those smallest biotechs with their equity stories to helping the biggest biopharma eyes with our precision medicine strategies, or, you know, working with some of the most exciting diagnostic companies.

02:34:22:18 - 02:34:45:06

Alasdair Milton

And so at the end of my career, I'd love to look back and see the work that that we did here at KPMG. It really moved the needle. And I come back to this idea of prevention that moved the needle on how we move health care and disease from, from, from treatment to prevention. So how can we identify patients earlier who are at risk of developing disease?

02:34:45:08 - 02:35:07:00

Alasdair Milton

How can we intervene to make sure they have optimal outcomes? How can we continue to monitor them on their health care 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, and lucky to have that opportunity.

02:35:07:15 - 02:35:26:16

Christian Soschner

Absolutely. There's a lot of work that needs to be done to, get society to. And at the end of the day, to the great vision that you outlined, instead, we have a great conversation. I really love it every single second. Before we wrap it up, other topics open that you would like to discuss. It's the final part.

02:35:27:23 - 02:35:54:22

Alasdair Milton

I would just, I maybe want to just cover some of the, the, the key conferences. I know the audience here is, is very much focused on the biopharma space and the early investors. And so I just, I'd, I 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.

02:35:54:22 - 02:36:16:21

Alasdair Milton

You're going to 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 going to get great opportunities to, you know, speak with industry leaders. So I think that would be one thing we can I didn't talk on. That's those are conferences that we attend regularly.

02:36:16:23 - 02:36:48:16

Alasdair Milton

I think if there's one thing I'd want people to take away from today, though, it's, you know, engage more with, with your health. And, we didn't talk too much about this with KPMG. Did a documentary last year on precision medicine. We talked about some of the leakage gaps, and the slide that I showed, and we brought in different, stakeholders from across the ecosystem, like pathology or some colleges, industry patients to give their perspectives on, on the ecosystem and why we saw those gaps and how we have to work together.

02:36:48:16 - 02:37:06:22

Alasdair Milton

And what came out of it for me was, that people don't engage with their health enough and their health care 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 health care.

02:37:06:24 - 02:37:15:04

Alasdair Milton

And if we can, if we can do a better job of treating up front and preventing disease, then it's going to be better for the individual and for society.

02:37:15:16 - 02:37:21:06

Christian Soschner

Yeah, absolutely. Absolutely. Aiming to taking more care of self makes absolute sense.

02:37:21:08 - 02:37:24:02

Alasdair Milton

Yeah. It's been a pleasure Christian. Thank you so much.

02:37:24:04 - 02:37:34:05

Christian Soschner

Alistair. Thank you very much for this great conversation and loved every minute of. My final question to you is, how can listeners best reach out to you?

02:37:34:07 - 02:37:49:04

Alasdair Milton

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

02:37:49:06 - 02:38:09:03

Christian Soschner

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

02:38:09:05 - 02:38:11:08

Alasdair Milton

Definitely. Thanks, Christian.

02:38:11:10 - 02:38:12:02

Christian Soschner

Have a great day.

02:38:12:02 - 02:38:13:15

Alasdair Milton

See you too. Like.

02:38:13:15 - 02:38:58:02

Christian Soschner

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.

02:38:58:04 - 02:39:34:09

Christian Soschner

The next decade will reward those who understand translation and not just innovation. If this episode sharpened how you think about health care, capital, or the future of medicine, take a small lecture. Now. Follow the show. That's how these conversations keep reaching the people shaping real decisions. And if you know someone who allocates capital, builds companies, or influences policy in life sciences, send these episodes to them.

02:39:34:11 - 02:39:55:08

Christian Soschner

That's how the system start. 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.