Conversation with the President

Billy Tauzin | President and Chief Executive Officer
Pharmaceutical Research and Manufacturers of America
Annual Meeting | San Antonio, TX | April 4, 2009

Five years ago, I enjoyed a privilege few Americans have ever enjoyed. I could – and did – have extended conversations with our nation’s Presidents. Conversations about politics and policies. And, sometimes, just conversations.

I remember so many of those conversations: My first meeting with President Carter – I showed up an hour late, and he was kind enough not to mention it. But I noticed he never laughed at my jokes. President Reagan loved my jokes. In fact, in one of our meetings during his recovery from the John Hinkley shooting, he laughed so hard he couldn’t catch his breath and started turning blue. The Secret Service guys moved in to help, and I imagined the headline “Tauzin kills President with Boudreaux story.” Thankfully, President Reagan recovered and caught his breath. Then Vice President Bush leaned over from his chair and said “Tell him another one, Billy.” You always have to watch your VP, when you’re President.

I remember paddle ball games with President Bush, No. 41, in the Rayburn gym, and more serious conversations, like the report I brought him from the war front, on the Kuwait border. I remember policy discussions with President Clinton and deciding that this guy could sell ice to Eskimos if he ever wanted to.

I remember all these conversations like they were yesterday. At the time, I didn’t think it was such a big deal – just everyday, normal conversations.

Now, I now realize how special each one really was – like the evening at Ford’s Theatre with President George W. Bush, on the eve of the decision to begin the Iraq War. President Bush spotted me in the crowd, called me over, and asked about a problem I was having with Karl Rove. I assured him the problem was inconsequential compared with the decisions he was about to make: to send our soldiers into harm’s way. I also assured him that Cecile and I prayed for him each night, and he actually teared up –right there in the middle of Ford’s Theatre. Then he did something even more remarkable. He leaned into me, kissed my cheek and whispered to me “and I love you both for that.” I remember the poignancy of that moment – and then I held him back and said “Well, if you love me that much, could you take care of Karl Rove for me?”

Today, I wonder how many Americans would have wanted to have a face-to-face meeting with President Bush that night. For me, that night was just one of many conversations with another President.

That all came to an end with that unthinkable, almost surrealistic moment when I was diagnosed with cancer and told that I had to concentrate on nothing but a long and dangerous fight for my life. My first task was to surrender all of the privileges I had so taken for granted as a senior member of the United States Congress, including access to conversations with our nation’s Presidents. Now I wonder, how did I ever think so little of the privilege?

Today, I wonder what it would be like to have a good, extended conversation with our new President – a chance to tell him about the incredible experience it is for me to now serve the men and women most responsible for saving my life.

If I could enjoy that privilege with President Obama, what would I tell our new President? What would such a conversation look and sound like? I can only imagine. But let me try!

I see us, not in the formal atmosphere of the White House, but maybe sitting around a campfire, under the big sky of my Texas ranch, just 70 miles southwest of here. We’ve just finished touring the ranch. I’ve shown him my new wind generators and my solar-powered wells, and President Obama is in a good mood. He is pleased that an oil-soaked former Congressman from Louisiana turned Green. We’ve settled down with a Bud Light, or maybe a glass of California red, and the campfire warms us in the reddish glow of a spectacular sunset and, to the east, the rising of a bright spring, full moon.

“Mr. President,” I would begin, “thanks for sharing such a great day with me and Cecile. You know, I didn’t have the chance to express to you how your election has affected us – especially having grown up in deep, south Louisiana, but let me to tell you now.

“I realize there are many for whom your success last November has deeper and more impactful meaning, but we, too, are still in awe of it all.

“In 1961, as a student government officer at my Alma Mater, Nicholls State University (we affectionately call it Harvard on the Bayou), it was John Kennedy who inspired my generation to public service and to politics. We did our small part in those Civil Rights years, pressing our Administration to voluntarily integrate the campus and personally introducing our new co-eds to our fellow students. And it was leading the effort to repeal the old, already declared unconstitutional Jim Crow laws that led me to run and win election to the State Legislature in 1971. You see, like you, I started as a community organizer, working in Thibodeaux, with LaFourche Parish Community Action.” What? “Yeah, yeah, I know Chicago is a little bigger than Thibodeaux – but we had work to do too. The point is, I know the journey you have made, but you and I both know that our country had to change for all this to happen – and what we feel today in your election has less to do with you personally – with all due respect – and more to do with the journey our nation has traveled and has yet to travel.

“So the great torch you carry today is, as Charlie Brown would say, ‘a heavy burden.’ I asked you to come to the ranch today – not just to enjoy the ranch, but to let you know that we in the biopharmaceutical research community not only want you to succeed with comprehensive healthcare reform, but that we are prepared to help you shoulder that burden and to help you carry that torch.

“Mr. President, I am alive today because of the great scientists who work for the companies I now serve. Their amazing discoveries are keeping more and more people alive today, who just a few years ago faced not just a frightening diagnosis, but a certain
death sentence. The men and women working at biopharmaceutical companies are truly doing God’s work on earth. They deserve our appreciation, not our anger. They are certainly not the ‘bad guys’ described by your opponent during the debates of the last election.

“You have called for a war against cancer to find the cures that, in our lifetimes, will put an end to cancer, just as we once managed to put polio behind us. Cancer, in all its many forms, will continue to be an illusive enemy. Finding the cures will take the collective talents of publicly-funded researchers and a lot of great academic work, but it will be the scientists who work for our companies who will innovate, develop and clinically test the actual vaccines and therapies that will win this war. We already are heavily engaged with a more than 800 new cancer medicines being tested. We are, in a real sense, your foot soldiers in this war. If this war is to be won, you will need us, just as we will require your support.

“Give me a few more moments to make our case to you, and to demonstrate that we are ready to help you succeed in this great challenge and in the broad challenge of healthcare reform.

“Mr. President, could you put another log on the fire while I get us another drink? Oh, yeah, I forgot – the rules have changed. Sorry, you have to buy. OK, well, first, let me set the record straight. I know you ran a couple of ads during the campaign we didn’t like. But you won – so we forgive you.

“That being said, let me thank you, Mr. President, for the invitation to join you and Nancy-Anne DeParle at the White House for your Health Care Forum. It was a good start. You often said during your campaign that PhRMA would have a seat at the table, but that we just couldn’t own the table. That was a good line. Well, you kept your word, and we appreciate that. And, by the way, we don’t need another table; we’ve got all the furniture we need. Just kidding! And we agree with you that making sure that all Americans have good health insurance for the health care they need is not only the right, moral thing to do, it is also an economic imperative. We’re ready to stay at the table with you until the job is done. Like you, we’re not afraid of change.

“I hope you have noticed that PhRMA and our member companies, like our nation, are already going through great change. Our companies, big and small, continue to be among the most research-based and innovative companies in America, but they, like the rest of our economy, are feeling the strains of recession and tighter margins which require cost-cutting and substantial layoffs. Yet they continue to invest in record numbers in research into new medicines to battle disease, so that today 70 percent of the global R&D investment by U.S.-based companies is spent here in America, employing directly and indirectly more than 3.2 million Americans. We have collectively declared ‘disease’ as our only enemy and our willingness to work with anyone, liberal or conservative, Democrat or Republican, who shares our passion for the work of saving and improving human lives. PhRMA is truly a nonpartisan organization, Mr. President, as patient centric as any in the healthcare community. We have changed, and you should feel as comfortable working with us as you feel on a basketball court or in the White House or here on my ranch tonight. We will always talk straight to you and when we give you our word, we keep it. If ever we can’t agree, we’ll tell you why.

“And the truth is, Mr. President, that we will not be able to continue to lead the world in medical innovation and discovery without your active support. In fact, you have made yourself, through your election, the single most relevant factor in our mission to battle cancer and other diseases – as indispensable to us as we speak here in Texas, as rattlesnake boots in rattlesnake country.

“For years, Mr. President, we in PhRMA have had to play constantly on defense – fighting off one misguided proposal after another -- proposals like importation of dangerous counterfeit drugs, government price controls, and oppressive litigation, assaults on our intellectual property rights and our patents on new discoveries. These assaults often were often based on bad information, and, in some cases, on hard feelings and some downright prejudices. Some of the political hard feelings and wounds have been self-inflicted. We have made mistakes, for which we take responsibility, but we have taken steps to right those wrongs and correct those errors. It is now time for us to move off defense and to aggressively fight for a more supportive and positive environment for the continuation of our work here in America, to innovate and discover the medical miracles of the future, or else that critical work will be done in some other country.

“We are doing our part to merit this request. We are now operating under strengthened codes of conduct in marketing, in clinical trial disclosures, in advertising, and we will continue to enhance those codes and our compliance with them. We are working with the FDA on new surveillance systems to catch safety problems early and deal with them appropriately. For four years now, we have operated a nationwide hotline patient assistance program for America’s poor and uninsured, and our companies have provided access to programs that offer free or nearly free medicines to over 5.6 million patients. Internationally, we are working with the WHO, the Gates and Clinton Foundations, and others to broaden the $5 billion effort to provide access to our medicines to deal with neglected diseases of the world, and we are building a virtual research consortium to advance early research on tropical diseases that have largely been totally ignored. Here in America we are working with NORD, NIH and others on more than 6,000 rare diseases that each plague small segments of our population, but together affect more than 20 million Americans.

“Mr. President, I submit, we are not the bad guys.

“Let me tell you what else we also are not. We are not, as you may have been told, the big cost drivers in the U.S. healthcare system. The biggest cost driver is clearly chronic disease, itself. Most people now know that America spends 75 cents of every healthcare dollar in dealing with the damage done by the big five chronic diseases, because we haven’t prevented, detected or treated them when we should have. But what you may not know is that medicines today represent only 10 percent of the U.S. dollar spent on health care, and that 10 percent is largely spent in helping patients manage their chronic diseases in a way that keeps them out of high-cost hospital care.

“Look, I would not kid you into believing that most of our companies are not profitable. We are. But if you took away all our profit – all of it – you’d only reduce healthcare costs in America by about 1.5 percent – hardly the big, deep pockets you will need to fund healthcare reform. And those profits by the way, Mr. President, help fund nearly $70 billion of medical research each year, more per U.S. worker – $70,000 each – than any other knowledge-based enterprise in America – or in the world. Without that research, cancer and her allies in death would surely succeed over us.

“And another thing: please don’t buy into the claims that the costs of medicines are rising out of control. Average drug costs in America did not rise last year by more than 7 percent as some have claimed. IMS estimates that drug costs increased last year by just over 1 percent. You see, critics who focus on the cost of brand-name medicines cleverly omit the fact that today 71 percent of medicines used in America are generics, one of the highest generic use rates in the world. You know the old saying -- there are lies, damn lies and then there are statistics. The truth is average drugs costs are basically flat.

“No, I’m not kidding you, Mr. President. We are not your problem and we are certainly not the bad guys!

“Let me tell you what we are: we can be, and we intend to be, part of your solution.

“Through our Partnership for Prescription Assistance program alone, in four years we have given away about $14 billion of medicines to our nation’s poor. Have you seen Big Oil giving away free gasoline to poor Americans? How many Big Insurance companies give away free health insurance to anyone in need in our country? Yet American hospitals and doctors and nurses and our companies provide more than $70 billion each year in free care, free hospitalization and free medicines to America’s uninsured.

“When all Americans have good health insurance coverage that especially covers the medicines that can prevent, and/or manage the diseases that otherwise cost us so much in damage control and lost productivity, we’ll be a healthier and wealthier society. When copays for needed medicines and other barriers to quality care are not so high that nearly half of all prescriptions written by doctors for their patients go unfilled – yeah, that figure shocked me too, Mr. President – then and only then will we have a healthier America, and a true healthcare system – in contrast to our current ‘sick care’ system. If patients could get the medicines they need; if copays were reasonable; if we could focus on prevention and wellness; if we are encouraged rather than discouraged from continuing to discover and make the new products to prevent, manage and cure, we will all come out as winners. All of us: payers, patients and health care providers. It could be like the U-Conn, Villanova, Michigan State, UNC – and even Duke – all winning the NCAA Basketball Championship all at the same time. And, by the way, that might get you off the hook with Duke.

“Let me explain how this can really happen.

“You see, Mr. President, medical innovation is not a bad thing – it is a great way to save costs in our system. Look at what it has already saved our country – with medicines that keep HIV from evolving into full-blown AIDS, with cardiovascular medicines that have helped coronary deaths plummet by 25 percent, a much faster rate than the targets set by the American Heart Association, with deaths due to cancer falling for two consecutive years for the first time in our history with the disease."

“New medical innovations will continue to evolve into precise and even personalized medicines with predictable good outcomes as the science of genetics, molecular biology improves and the understanding of disease pathways and biomarkers deepens and widens. Medical innovation will, if supported, produce cost savings, better outcomes, safer medicines and help our nation remain competitive in an increasingly competitive global economy. What our nation can save alone, if we but delay the onset of Alzheimer’s by five years is astronomical.

“Mr. President, I know that Air Force One is probably revving up its engines in San Antonio, but spare me a few moments to give you a candid assessment of what we need and what we believe we can deliver.

“First, we ask that you lend us a little trust. I say ‘lend’ because we obviously have to earn that trust by our good works and deeds. We intend to do just that.

“Second, please put away any preconceived notions you have of us. We need to do this work together, all of us: Democrats and Republicans. That’s why we are working today with labor, Families USA, America’s Agenda and others who have joined us at your table. I’m sure you know that I have been both a Democrat and a Republican. In fact, Senator John Breaux called me a transvestocrat. I can help you here.

“Third, I ask you to consider some bold ideas. Why not a National Commission on Breakthrough Medicines to assess the environment around medical innovation in America and then to advance, not just a war on cancer, but a war on diabetes and HIV AIDS and Alzheimer’s and beyond?

“Mr. President, America is not necessarily destined to hold our 70 percent world leadership in biopharmaceutical research. We are not necessarily destined to continue to provide some of America’s best paying jobs for 3.2 million Americans. Worst of all, we are not destined, as patients, to always have early access to the best new medicines in the world because most of the research and the clinical trials are conducted here.

“Here are some hard facts, Mr. President, that we, unfortunately, need to digest – like a good gumbo gone sour.

“Last February, the Information Technology and Innovation Foundation reported that the United States now ranks sixth among 40 nations and regions surveyed in innovation and competitiveness, but we rank dead last in terms of progress over the last decade. Since 1986 our share of scientific researchers fell from 41 percent to 29 percent. We now graduate less than 15 percent of our students in science and engineering, compared with 67 percent in Singapore and 42 percent in China. Since 1986, the number of doctorates in science and engineering has decreased by 30 percent.

“We’re going the wrong way – and others have noticed. For example, Prime Minister Brown has commenced Project #10, to create a more favorable environment for innovation in the UK and has invited our companies in for consultations. China has declared that it intends to lead the world in medical innovation by 2040, and has begun offering rich rewards for Chinese scientists to return to China from the Untied States. Singapore is offering near tax-free residence for our investments.

“The question is: What are we in America prepared to do to maintain our leadership?

“You know, doctors have it right, Mr. President, when they say ‘First Do No Harm.’

“Let me be frank here: tax changes that encourage our companies to invest elsewhere make no sense. If a new tax policy cheapens our companies, making them easy targets for foreign acquisition and relocation, maybe you might wish to reconsider those ideas. Huge increases in rebates, extending rebates to private sector sales, government intervention into private negotiations, weakening the incentives to research new biologics, all could harm, rather than strengthen the environment here – things a good doctor would never do to a patient in need.

“More importantly, a good doctor would conduct a thorough diagnosis of the situation before deciding on any treatments.

“So, why not a Blue Ribbon Panel on American Competitiveness in the Life Sciences? And here are some questions the Blue Ribbon Panel might ask:

“Can we educate more, rather than fewer, scientists and engineers? As Leader Dick Gephardt asked, ‘Can we make science sexy again?’

“Is our tax code designed to keep innovative jobs here, or does it encourage them to leave?

“Is our regulatory policy as good or better for innovative activities than any in the world? Is our current FDA, for example, up to the challenge? We don’t think so.

“Is our legal system making it easier or harder to make the risky decisions to invest in new products?

“Are our patent and intellectual property protections as good or better than any in the world?

“Have we forgotten how hard it is to place a billion dollar bet on a new medicine (10 to 14 years out), that the science behind the medicines will work, that we can identify the safety concerns properly, that regulators will not unnecessarily delay us or surprise us with new requirements, that we’ll have time left on our patent life – that is fast running out even as we test our medicines, that we’ll somehow walk the maze of patent challenges and at-risk generic launches, and that we won’t be sued or prosecuted into confessing guilt over allegations of misconduct over which we are not practically permitted to defend ourselves, or that some legislator somewhere will make it harder and harder to market our product in a professionally-acceptable fashion with new liabilities with retroactive standards and regulations?

“I apologize for being so animated over this, Mr. President, but I do not exaggerate. Our country is making it more and more difficult for us to carry out our mission to save lives, and I am fearful of our future here.

“Mr. President, we need your help to change all that and if you do, let me tell you what we can do for you and all Americans.

“With the right kind of biologics policy that rewards research and development (with adequate data exclusivity protection periods for biologics, for example), we can help you win the war against cancer – and many other diseases.

“With a well-resourced and less risk-adverse FDA we can reduce our development times and bring new treatments and cures to market with a more precise understanding of their effectiveness and safety profiles.

“With your support for the NIH and basic research in academia, we will use that new knowledge to make more precisely targeted medicines, used more effectively against better diagnosed versions of disease – with real cost savings, to boot.

“With tax policy that encourages us to make our investments here rather than somewhere else, we will grow the $88.5 billion contribution we currently make to U.S. GDP, which today already is triple the average contribution from any other sector in the U.S. economy.

“With just a little tough love and understanding, we can help you see that all Americans are insured; we can end the intolerable presence of healthcare disparities in our African American, Hispanic and other minority communities; we can help see to it that the medicines we make to keep people healthy and out of hospitals are covered better by insurance and more accessible, with lower, more affordable copays.

“And, with God’s grace and blessings, the 600,000-plus men and women who directly work in our companies will work beyond the quest for new treatments and cures, into that amazing possibility of medicines that actively prevent genetically-inspired, predictable diseases from ever getting started – a place where your kids and mine will not have to go through what our generation of patients have to go through. Chemo, Mr. President, is no walk in the park.

“I know personally what a real can-do attitude really can do. Five years ago, despite extensive surgical removal of parts of my stomach, intestines, and pancreas, I showed up at M.D. Anderson for clean-up chemo only to learn that I still had cancer in a lymph node that could no longer be removed or treated with any approved medicine.. Several weeks ago, on St. Patrick’s Day, my oncologist joined my drinking buddies for a DC dinner party that my incredible wife arranged for us, to celebrate the anniversary of that fateful time five years ago. At the party, my oncologist answered when asked, that my chances when he saw me in 2004, were down to 1 percent – with a 1 percent margin of error. But he also said that if you know Billy, that 1 percent was all he needed. Well, truth was, I also needed a miracle.

“Mr. President, that miracle came in the form of a chemo cocktail made up of a drug made by a French company – doing most of its research here in America, by a drug made by a Swiss company, doing most of it research work here in America, and by a California American biotech company, which had just produced a new miracle drug for cancer, called Avastin.

“I want to take my PhRMA hat off, for a second, Mr. President, and speak to you as one of the millions of Americans who have survived cancer. When I was first diagnosed with cancer, I did not think I would never have the chance to see my grandchildren. Today I have two. Or, more importantly, those two grandkids have a grandfather to love and nurture them. When I was diagnosed, I did not think I would have the chance to walk my daughter down the aisle. But my daughter did have her father to walk her down the aisle. You see, Mr. President, it’s not just a victory for us to survive cancer, it’s a victory for everyone we love and for those who love us.

“I was sitting behind you in the balcony of the U.S. House Chamber, when, in your State of the Union Speech, you declared the newest war on cancer. I could not see you – I could only hear your voice. But I heard real conviction, real passion and my heart leapt for joy. Those two young grandsons of mine don’t know it yet, but maybe – just maybe – because you are willing to work with us – they will never have to worry about the genes they have inherited from me. Maybe, just maybe, they will never have to have their careers cut short and their lives shattered by a diagnosis all of us fear and too many of us share.

“You have two lovely daughters, Mr. President. God blessed me with only one – but she is so precious to me. At our Annual Meeting this year, we honored with our Discoverer’s Award a new anti-cancer vaccine called Gardasil that can protect your daughters and mine, and maybe even my sons and grandsons from a deadly form of cancer that could strike down their young lives.

“Please don’t miss the chance you have been given to not only declare this war against cancer, but to actually win it – so that we can move from that victory to victories against Alzheimer’s, HIV AIDS, diabetes, Parkinson’s and all the thousands of diseases that challenge mankind.

“We are up to this work. We have stretched our hands out to you – not seeking a handout – but only a hand of friendship and partnership.

“Many are surprised that we have already reached across old barriers, to have this conversation today. Many say this will go nowhere. That it’s just so much ranch talk, that we cannot find common ground. To them I say, and, by the way, you can use this in a campaign if you like, ‘Yes, We Can!’

“Help me out here – Yes We Can. Yes We Can. Yes, We Will.

“Thank you, Mr. President. May God bless you and our great country. Good night, Mr. President."