Extended Interview: Sidney Taurel
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SUSAN DENTZER: Let’s go back for a moment to 1987, when Prozac comes on the market in the United States. What did the company think it had on its hands at that time?
SIDNEY TAUREL: We thought we had an innovative drug, but we did not realize what its potential really would turn out to be. We had no idea. At the time, we did not even have a full-time psychiatrist on board at Eli Lilly. So things have changed a lot since 1987.
SUSAN DENTZER: You didn’t have a full-time psychiatrist on board?
SIDNEY TAUREL: Correct.
SUSAN DENTZER: And still managed to come up with this drug.
SIDNEY TAUREL: Yes.
SUSAN DENTZER: Luck?
SUSAN DENTZER: Dumb luck?
SIDNEY TAUREL: Well, we had–we had some excellent scientists in the discovery area, and the clinical development was done by a clinical pharmacologist, rather than by a psychiatrist. And so we learned to–there were some mistakes made at the beginning of the development of the drug, in terms of how to best get a drug like this to the market, and it took longer than one would have expected. The approval by the FDA took four years.
SUSAN DENTZER: Was there a full understanding that, as an SSRI, this really was going to bring a new dimension to the treatment of depression?
SIDNEY TAUREL: Not a strong understanding of that. It became very clear, once the product hit the market and we started to get all of these wonderful stories from patients whose lives were being completely transformed by Prozac.
SUSAN DENTZER: And this quick–very quickly became almost a cultural phenomenon.
SIDNEY TAUREL: Uh-huh.
SUSAN DENTZER: Did you expect that?
SIDNEY TAUREL: No, we did not. It went way beyond our expectations. I think we–we knew by, by the early ’90s that we had a fantastic product on our hands. It was really revolutionizing the treatment of depression. What we tried to do is to also help people understand depression, help people seek treatment. Because, in those days, only 30 or 40 percent of the patients with depression would ever seek treatment.
And, also, many general practitioners, primary care physicians, would treat some of the symptoms of depression, the sleeplessness, the headaches, or what have you, without treating the syndrome, without making the clear diagnosis. So we were very involved as a company to make sure that psychiatrists would talk to their colleagues in general practice to help them understand what the symptoms of depression are.
We also worked a lot with patient association groups to ensure that they would talk to patients and get people to understand really the nature of this, of this illness. That is really like a physical illness and not a weakness, and that was actually the theme of the campaign that we had with the patient association groups: depression is an illness, not a weakness. And I think all of that contributed to the tremendous impact that, that Prozac has in destigmatizing depression. And I think, even beyond that, it has had a tremendous impact in destigmatizing mental health, in general.
SUSAN DENTZER: One executive, I believe an executive of Lilly, was quoted in a Business Week article as saying, “No company has ever survived a patent expiration of this type,” in terms of the magnitude of the product and its contribution to profitability and the impact following patent expiration.
Do you think Lilly is going to survive this?
SIDNEY TAUREL: Yes, I think the second part of that assertion–the statement was, “And Lilly will be the first one.” We believe, you know, the way we have made history with Prozac, we will, again, make history by not only weathering the storm created by the Prozac patent expiration, but also emerging out of that as the growth pharmaceutical company of this decade.
I truly believe that between the five products that we launched in the last five years and the ten products that we are expecting to launch in the next three years, Lilly will be able to come out in 2003 and beyond as the fastest growing company in our industry.
SUSAN DENTZER: I’d like to just go over some of the other Prozac issues, many of which I know have been largely laid to rest, but they still remain in people’s minds– obviously, less an issue now for this company now that–it’s more an issue now for the generic manufacturers.
The allegations about overuse of Prozac, which, in fact, some people have become quite worried about as internists, in general, family care providers also became active subscribers of it, what is Lilly’s sense of whether there was, in fact, lots of overuse of Prozac and lots of prescribing of Prozac for people for whom it was inappropriate?
SIDNEY TAUREL: We don’t have a lot of evidence that there has been a lot of that. I think there is certainly some, but you can make an even stronger case that a lot of people are still not diagnosed and treated properly for their depression.
At this stage, I think the estimate is about 55 to 60 percent of people who have depression are being diagnosed and treated. So that leaves another 40 to 45 percent of the people who are yet–who are not yet being treated.
SUSAN DENTZER: We’ll come back to that in a moment, but I want to ask you the allegations that the drug Prozac did produce some increase in suicidality among a certain group of patients, what is the company’s bottom-line belief about that?
SIDNEY TAUREL: Our bottom-line belief is that Prozac has saved millions of lives. Suicide is, unfortunately, a manifestation of depression, and no antidepressant works on 100-percent of the patients. So there are some patients on whom the product, and other antidepressants, don’t work and who end up committing suicide. But on two-thirds of the patients the product works, and that avoids a lot of suicides.
SUSAN DENTZER: Some people have raised a concern about the long-term use of fluoxetine, that there–and have pointed out that one of the ironic sort of anomalies of the product now becoming a generic is that nobody really has a vested interest now, in terms of a drug company, in studying the long-term use and nobody probably has the resources of one of the major manufacturers now to devote to a large clinical trial about long-term use. Do you think that’s an issue?
SIDNEY TAUREL: Well, I think what we are doing is taking all of the learning that we’ve had from all of those years of experience with Prozac and applying this as we do more research on improvement. And duloxetine is the first product of that.
SUSAN DENTZER: But is there adequate knowledge about the long-term use of fluoxetine?
SIDNEY TAUREL: I believe you have so many thousands of psychiatrists and primary care physicians out there who have had years of experience with a drug. So many patients have been on it for many, many years that I think we know as much about this product as we know about just about any other product, you know, in the market.
SUSAN DENTZER: And there’s nothing so far to suggest that there’s anything different, by virtue of the safety profile, of long-term use versus a much shorter-range use.
SIDNEY TAUREL: Not to my knowledge, no.
SUSAN DENTZER: We saw the poster coming up the stairs, and you mentioned also the slogan, how does it go, “We made history with Prozac–“
SIDNEY TAUREL: “–history with Prozac. Let’s do it again.”
SUSAN DENTZER: Why is it important to have that kind of a slogan now for this company?
SIDNEY TAUREL: Well, clearly, our organization is facing the biggest challenge in the company’s history when you have a product representing more than 20 percent of your sales go down fairly precipitously, as we can expect in the next 12 months. That creates a major challenge for an organization.
So it’s very important that a great sense of urgency be created so that everyone in the organization is focused on, on delivering results and delivering results for us means growing the five new products that we launched recently and making sure that every product in our pipeline has been launched successfully.