MappedCon presented by Blueprint Test Prep 2024 is this Friday, October 26, 925 Eastern. I'm starting the day in my track, the pre-med track, planting the seed of your personal statement. We have three tracks going all day long and a couple hours of amazing exhibitors where you can learn more about their programs. Again, MappedCon presented by Blueprint Test Prep, October 26, register for free. It's a virtual event and all the sessions will be up after. So even if you can't make it live, go register and get access to the sessions. Go to MappedCon.com right now, register. That's M-A-P-P-D-C-O-N.com. If you're applying to medical school in 2022 to start medical school in 2023, join me Wednesday or Thursday, Wednesday night at 9.30 p.m. Eastern or Thursday at 11 a.m. Eastern at premedworkshop.com. Go register today. I'm going to show you how to tell your story in your application. Again, that's premedworkshop.com. If you are applying to medical school in 2022, be there or be square. The medical school HQ podcast, session number 72. It really is. I mean, you have to look in your heart and ask yourself, what do you really want to do? And don't worry so much what other people may say about your choice. Hey, this is Z-Dog MD, rapper, physician, legendary turntable health revolutionary and part-time gardener. And you're listening to the medical school HQ podcast hosted by the irredeemably awesome Ryan Gray. Oh, welcome back. I am your host, Dr. Ryan Gray. And I believe that competition amongst your premed and medical student peers is detrimental to becoming a great physician. In this podcast, we show you how collaboration, hard work and honesty are critical to becoming a superior physician in today's health care environment. Before we get started with this podcast, I am excited to announce that the Princeton Review has decided to support us and support you by offering an amazing exclusive discount to the medical school HQ podcast listeners. That's you. For the month of April, when you use the code MS HQ for the number four, you will save $225 off the Princeton Review's MCAT Ultimate Classroom or MCAT Ultimate Live Online course. Using that code not only gets you the best discount available, but also helps support our podcast. Thank you to the Princeton Review for your continued support. I also wanted to talk for a second about the Academy at the medical school headquarters, an online membership site to help you through the premed and medical school process. With live monthly video question and answer sessions, monthly live webinars covering everything from the MCAT to financial aid, you can't afford not to join. Start investing in your future now and join the Academy. One of our charter members, Grace, had this to say about her experiences with the Academy. And I watched some of the office hours through the Academy. And just, I don't know, I guess it just makes me more determined to become a doctor because you guys make it seem more like possible, I guess. It doesn't seem like an impossible dream. Come join Grace, Allison, myself and so many other great minds and join the Academy today. Go to jointheacademy.net to sign up. I'm excited to announce the guest for today. Our guest is Dr. Al Sandrock. He is the Chief Medical Officer and Senior Vice President of Development Sciences at Biogen IDEC, overseeing clinical development and neurological and immunological diseases, global regulatory affairs, global safety and benefit risk management, global clinical development operations, and biometrics. During this podcast, you will hear Dr. Sandrock talk about his journey into the pharmaceutical industry, why he thinks the pharmaceutical industry gets such a bad rap from other physicians, and what you as a student can start doing to get some experience in the industry. Dr. Sandrock, thank you for taking some time to talk to us today. Who gave you the initial drive and passion for medicine? I think I did get it from my parents, where my parents really highly respected physicians, and I came on both sides of my family. My dad didn't even go to high school. He, but he wanted to see when he was 16 years old, ended up working on ships, and then he ended up becoming a ships captain, and he used to always probably say that when you're the ships captain and you're out at sea, you're also like everybody's doctor too, because there's a medical emergency. The captain has to take care of it, and he always found that very gratifying to help his shipmates out at sea. And then my mother, I think she did go to high school, but she's Japanese, and she did go to a special school for women, I think, but she also highly respected physicians. So that must have influenced me, and I think even before I went to college, I kind of had a feeling I wanted to be a doctor. Okay, and then you went to Stanford. Did you go to Stanford with the thought that, okay, I'm going to be pre-med now? Yeah, I identified myself as a pre-med really early on, not realizing that there would be a certain stigma attached to me for having identified myself as a pre-med, but I did. There was a stigma, I'm not dating you here, but there was a stigma even back then about being pre-med and wanting to be able to medical school? Oh yeah, oh yeah. What did that involve? Well, I mean, I don't know, you had closed your mind to other possibilities. You know, I attended, you know, my first chemistry class was 200 people, and I'd say 95% were pre-meds, and I remember the teaching fellow saying, derisively, "Oh, I got to teach all these pre-meds," and now them are really interested in chemistry, it's just a route to becoming a doctor. I don't know, there was a pretty negative stigma associated with it. Wow, it's interesting because there is still a stigma these days, and you would think at some point we'd go, "You know what, we need doctors, so let's help them out as much as possible." Yeah, yeah, I thought maybe the stigma had lessened, but oh well. So you go through Stanford, did you immediately apply to medical school at that point? Yeah, so at Stanford I got very interested in actually psychiatry, because I heard a lecture in my human biology course about how psychiatric diseases are caused by chemical imbalances in the brain, and that neurotransmitters look a lot like structurally or closely related to not only recreational drugs, but medicines that are used to treat important illnesses. So I started working in a lab, I worked for a child psychiatrist and ended up working on an enzyme that was in the catacolamine pathway. So I went to medical school, I applied right away to medical school, I applied to some ND/PhD programs, and at Harvard though, you couldn't apply directly to the ND/PhD program, you had to go to medical school first and apply to the ND/PhD program after a couple weeks ago. You could enter it after two years, so we had to apply during your first year, which I did. Okay, so it sounds like possibly from an early on period, you kind of had this interest in the more of the medication side of things, and developing products and pharmaceutical interventions for different diseases, it sounds like that was an early interest for you. Well, I wanted to cure diseases, you know. Yeah, and that's what all physicians want to do. Yeah, and just before I started med school, I was in New Orleans visiting my dad's from New Orleans, so we have a lot of relatives in New Orleans, and I remember one day it was a summertime before starting college, actually, that my uncle died suddenly of a heart attack, and he was a fairly young man, and I felt there, that was a defining moment for me because, you know, I had a lot of questions as to why he had to die, and so I felt like there was a lot of room to improve in medicine, and so that sort of what drove me, I think. Okay, when you started on your journey into the MD PhD realm, did at that point were you exposed to the pharmaceutical side of things, or were you still naive to that, and you knew you liked research, and you just wanted to use that part of it? Yeah, I was pretty naive to it. There was some exposure to the pharmaceutical side of things, and it was related to a lecture we got on infectious diseases, as I recall, and at Harvard there was a very strong anti-pharma sentiment, and I remember a relatively well-known infectious disease specialist talking about antibiotics. I think it was during my pharmacology lecture, pharmacology course, which I think was early in my second year, and he talked about all these different antibiotics, and I had to keep making new ones because bacteria became resistant, and then there was a medical student in the front row, a number of women who I think yelled at him almost saying, "Are you paid by pharmaceutical companies, and do you know how much pharmaceutical companies make or spend on marketing?" And I remember it was quite a tense moment in the class, and so there was a strong negative view. In the meantime, I started dating the woman that became my future wife, whose dad worked at Eli Lilly, and he started telling me how Harvard Medical students had actually burned the medical bags that Lilly used to donate to Harvard Medical students that apparently burned a whole bunch of these gifts on the quad one or two years before, so I had heard about the anti-pharma sentiment, which surprised me a little bit, as I recall, because I thought that I didn't realize that existed. Since you brought it up, I was going to talk about it a little later, but now that you brought it up, this anti-pharma sentiment, or I've heard physicians talk about it as going to the dark side, why do you think that is still around at this point? Well, I think I even joked when I came to a biogen that I was going to the dark side with my academic colleagues, so I think that, first of all, I think there's a lack of knowledge of what actually happens in a biotech/pharma company, and I think that most people, well, here's my theory that we are a for-profit company, and the idea that you try to make profits from six people just seems wrong to a lot of people. You can't even get off the first page that you should not be exploiting somebody's illness to make money. I think that's where it comes from. Okay. I don't know, but do you agree with that? You know what? I don't think I've spent too much time thinking about it, because as a physician, you rely on pharmaceuticals to treat patients, so in the world that we live in, in a capitalist world that we live in, companies are built to make money, and if you're making money, great, but if you're saving lives, even better. So I don't come from it as a more of a anti-pharma idea. Yeah, but I think about the same way you do. I justify the fact that we make a profit by saying that we don't make a profit unless we make a drug that's worthwhile. And so by making a drug that's worthwhile for people, we make money as a result of that. I don't see that that's hurting anybody. In fact, I think it's helping people, but anyway, so, but you asked me where the anti-pharma sentiment came from, and I gave you one theory. It could be wrong. Yeah, it's probably a good theory. So you completed your MD-PhD. What did you do your residency in? What are you trained in? Yeah, I'm a neurologist. So I did one year of internal medicine and then did three years of neurology. Okay, and did you continue to practice clinical medicine at that point, or did you have that urge to jump straight into pharmaceutical? No, no, I did a fellowship in neuromuscular disease, and I also trained in electro-myography, and I got board certified in neurology and electro-diagnostic medicine. I became an instructor in neurology at Harvard, and then I decided to do a postdoc at Harvard to continue my laboratory sort of training while I was an instructor in neurology at Mass General. So I would go to Mass General for a day to see patients and spend the other four days a week in the lab, and I did that for about five years or four years, I think, four or five years. And then I became assistant professor and started a lab at Mass General. And then became, and then was on the staff at Mass General Hospital and saw patients. Two half days a week, one half day a clinic, and then the other half day doing EMG or supervising fellows doing EMG. And then I would do one month a year as award attending. And then be on call every now and then when I was the attending on call for the emergency room. So I continued clinical medicine, but it was not full time. It was mixed with laboratory work and also teaching. So at what point, and maybe this is where we start to kind of translate it into somebody listening who might be in that same situation that you were in, at what point did you start to dip your toes into the pharmaceutical industry and get exposure to that and start thinking about going over there? Well, when, so while I was doing my postdoc, I met a guy who was not only a physician and neuroscientist, but also an electrical engineer, and a really smart guy. And we ended up becoming lab partners and worked on a project together. And he actually, I had to do some recordings from animals, you know, like neurophysiological recordings from animals. And he was unbelievable because instead of buying an EMG machine or whatever, or a neurostimulator, he just made one. You know, he just bought the parts, put it together and programmed a computer to actually do it. But anyway, he ended up starting a company called Neurometrics. And he asked me to be on the scientific advisory board of a one person company. We actually, I tried to help them. We actually worked together on developing a prototype for his first product, which was a little point of care device that could measure nerve conduction in the median nerve and therefore diagnose carpal tunnel syndrome. And then we were using the standard EMG as the gold standard and comparing his device with sort of the gold standard that we used in the clinic back then. So in the context of that, I got intrigued by the idea of making products, working with them on that. And then we also had to go and shop our device around with some other pharmaceutical companies. And I distinctly remember a trip to Pfizer in Connecticut and grew up in Connecticut. And meeting some people there who were unbelievably smart. And not only were they smart, I liked the fact that they were very goal oriented. I mean, they wanted to get stuff done and get it done quickly and with high quality. So in the context of that, I learned, first of all, that unlike what I was led to believe during my academic training, there are smart people outside of Harvard. And actually, there are smart people in a pharmaceutical company. And not only are they smart, they're working together in teams toward common goals, which usually meant making a product. And I felt working with my friend there and learning about what people at Pfizer were doing, that there was a lot of satisfaction in making a product in the team setting. So that's what got me interested in thinking about industry. And in the meantime, I had a good friend, a colleague who was also a resident with me at Mass General in Neurology. And she moved over to Biogen and was working at Biogen. And she seemed very, very happy. And her husband was also had moved to industry. And he was a neurologist. He was our senior resident. So he was two years ahead of us. And he was talking about how great industry was. All these things were happening where I was getting exposed to industry in a very limited way, of course. And some of my colleagues had moved to industry and seemed to be having a great time. I don't know, they felt like they were finally doing something that they wanted to do and were trained to do. And so, in that background, my then wife actually was looking at the she's a physician too. And she was looking at the New England Journal. And there was an ad from Biogen saying we need a neurologist with five years of research training in neuroscience at Biogen. And by the way, Biogen's a company that just introduced a new drug for MS called Interferon Beta. So that caught her interest and she gave it to me to look at the ad. And my first reaction was why would I look at Biogen? I'm pretty happy at Mass General at Harvard and I just got my lab started. But I did respond to the ad and sent in my CV. And one thing led to another and I found myself interviewing here. And that was back in what year? That was 1997. And have you been there ever since? I joined in February of 1998 and I've been here ever since. Yeah. Wow. So obviously you've liked it. Yeah, I, you know, and when I interviewed here, I met people again, very similar to the kinds of people that I had met at Pfizer and after that, you know, and they, it was seen like a very exciting place. And it was a company that had made a commitment to neurology, you know, not only because they were looking for a neurologist, but also because they had a product for multiple sclerosis. So, so it was, it was very interesting to me. But I have to tell you, it took me four or five months to make the final decision because it was a scary leap. You know, it was the dark side. It was a world that I didn't really know as well as academia or academic medicine. And I, I knew I could do well in academic medicine, but I had no idea I would do well in biotech. So it was a scary jump. And it was not consistent with sort of the dream that I had, I think, growing up. You know, I think I had all, I don't know, at one point, probably while I was at Stanford as an undergraduate, I had imagined that I would be an academic, I would be an academic medicine. But to go into industry seemed to be divergent from my original thinking about my career. So it was scary from all those points of view, but I made the leap anyway. When during those four or five months where you were deciding, did you seek counsel from colleagues and what was their response? Yeah, I sought counsel from many colleagues, mostly colleagues in academia, because that's who I knew. And the response was missed. First of all, it was violent. Well, there were, there were a lot of people who felt that I was making a big mistake by going, including the chairman of neurology at Mass General, who said it was a big mistake, that those jobs are always available. And that why would you, why would you do that? One colleague at Mass General even said that I would be committing, I would be undergoing apoptosis, you know, program self that, that it was equivalent to death, going to bio biotech. But some of my other mentors, like the guy that I did the postdoc with who I admired greatly Jerry Fish Park, quintessential academic, as well as many of the professors that I, that were my, my teachers during grad school, quintessential Harvard academics, you know, they were not so negative. They said, you know, there's a lot of good stuff on there. And if that's what interests you, you know, you can make, you know, you should go wherever you feel you can make a good contribution. And, and, and so that was intriguing to me. Moreover, you know, a biogen was just across the river from Mass General, so it wasn't like I was going to have to move my family. And, and I actually kept my Harvard appointment, kept it for until I think a couple of years ago, in fact. So I could have gone back if things were terrible. So there was a bit of a lifeline back, although, you know, it's never good to leave and then try to come back. So I knew that it was, it was still a big decision. But, but yeah, it was a lot of, it was, I was surprised at how negative a lot of people were. But, but also surprised, pleasantly surprised that some of the, the older professors, people who I never would have imagined would have been, would have been open to the idea of my going. They were actually encouraging and thought it was very brave of me to even consider it. Yeah. So let's talk about some of the opportunities for a somebody that's on their path right now, maybe they're in medical school, maybe they're even just a pre-med at this point. What are some of the opportunities that once they're a physician, what opportunities are there in industry for physicians? Well, first of all, if you want to dip your toe in it, we have fellowship programs. We have two fellows now from Mass General, from the neurology department. We set up what's called the Ann Young fellowship. So they work sort of, they have one foot in the back at Mass General and one foot here, working on some things that are of interest in both places. So I don't know whether they'll end up coming to biotech or not, but they are certainly getting a feel for what it's like here. What stage are they in? Are they residents? Are they attendings? They finish their residency and their fellows. Okay. So they're like a traditional fellow. Yeah. Okay. But, you know, and even earlier, if you're like a medical student or if you're an undergraduate, we have summer internships. We have a number of summer interns that come through here from college. And what are they typically doing during a summer internship? They're either working in the lab or they're working with one of the clinicians here on clinical trials or improving outcomes or looking at imaging as outcome measures, things like that. Okay. Once a physician is out practicing and is interested possibly in going into industry, is it something where you have to be die hard for the research side of things? Or are there other opportunities in industry for non-research buffs, maybe like myself? Yeah. No. I mean, you can go, first of all, you can go right to, you know, there is a path where you can work in the research lab. We call that discovery or we call it research, you know, R&D research. And then there's the development side, the D side of R&D, where we take compounds that have drug candidates that have been nominated to go into the clinic. And then, you know, actually do the animal, the toxicology studies and animals. We start phase one, and we do the phase one trials, phase two trials, and phase three trials, and that's all done by a whole team of people. But we typically have a physician who leads those teams. There's, right now, if I can, there's three general groups that MDs work in. One is people that is in that development group that I just told you about. Some people call it clinical development, but the other is drug safety. So, you know, as we go through the various phases, and even after we put a drug on the market, we're assessing safety and physicians working out, there are many physicians who work in our drug safety group. And then, after we market a drug, there's a group of physicians that work in what's called medical affairs, where they help doctors understand how to use the drug and understand better, like, what are still the gaps in knowledge about our drug that could help physicians use it better in practice and better health their patients. So, those are the three general areas that physicians work in at Biogen. And some other companies, physicians also work in the regulatory affairs department, where, you know, as we go through these various stages of drug development, you know, all that's done in a regulated environment. So, we have to interact with regulators, not only in the US, but also Europe and Asia. And then, of course, at the end, hopefully, if your drug is successful in Phase III, you seek approval. There's a lot of touchpoints with regulators, and we have a regulatory affairs group. We don't have any physicians currently in that role now, but in many companies, there are physicians in the regulatory group. So, you can use your MD in multiple ways in a company, just as you can in academia. Yeah, and that's exactly, I think, the picture that I wanted to paint, and we've told before, is once you get that MD or DO, there are so many doors that are open to you, and it sounds like it's the same in the pharmaceutical industry as well. Yeah, and by the way, when we interface with FDA or the European Medicines Agency or the Japanese regulatory agency, we're almost always interfacing with MDs on the other side. And so, you know, that's another route. If you're interested in the industry, but from the regulatory side, you can actually be part of the regulatory authority. Great. Once a physician tests those waters, do you have physicians that work at Biogen that continue to practice clinical medicine? Yeah, in fact, I used to still go and see patients or actually was an attending in the residence clinic for 10 years after I moved here half a day a week, and many of my colleagues still do that, so I'm actually keep their clinic growing. I didn't keep my clinic growing because I thought it would be too difficult to do, but I did attend in the residence clinic, which was great because, you know, I don't know whether the residents learned from me, but I certainly learned a lot from the residents that kept me up to date on what was going on in neurology, so it was good. And, you know, we encourage that at Biogen, because I think he keeps you current. Definitely. Well, Al, do you have any parting words of wisdom for a student on their journey and the hurdles that they have ahead of them and what they should be doing maybe if they're interested in the industry? I think I don't know if there were words of wisdom, but I would say that you got to follow what you got to do, what you really want to do. You got to follow your email. We use the word passion. I think we overuse it these days, but it really is. I mean, you have to look in your heart and ask yourself, what would you really, what do you really want to do? And don't worry so much what your, what other people may say about your choice. Look into your heart and do what you, what will make you happy, and productive, and, and, and don't worry about what others say. Well, I hope you enjoyed that episode talking to Dr. Al Sandrock about the pharmaceutical industry and kind of opening up your eyes to what else you can do as a physician. And you don't necessarily have to be an MD PhD. Dr. Sandrock is, but you don't have to be to get involved in the pharmaceutical industry. So if you're interested in that, there's, there are many ways to start looking. And Dr. Sandrock talked about some of those as far as the summer internship. So thank you, Dr. Sandrock, for taking the time to teach us a little bit about that. Before we close out here today, I do want to thank several people that have left us five star ratings interviews in iTunes. I like to thank those that do personally because it helps the podcast tremendously in iTunes. So if you haven't done that yet, if you go to medicalschoolhq.net/itunes, there you can leave us a reading interview. It takes a couple minutes and helps us tremendously. I want to thank Guy Giddy, says awesomeness. Jamie Elise says amazing. Kaiser MD says we are a great resource. And wow, Agnes Zaca 020 says it's a great podcast. We have many more since the last couple of weeks. We haven't listed anybody. Haven't thanked anybody. And that's because our last couple of podcasts were actually prerecorded since Alison and I were enjoying the birth of our first baby. We prerecorded some podcasts so that we were able to get them out on time to you. And so now we're catching up on some of these awesome ratings interviews. So thank you to those four people. I have many more to thank next week. If you want to say hello to us want to congratulate us on having our baby. We're on Twitter. I am at medical school HQ. Alison is at Alison underscore MS HQ. You can just shoot me an email. I'm Ryan at medicalschoolhq.net to say hello. I also do want to remind you that we have an awesome new 30 plus page report on the most important pieces of the MCAT. You can get that at free MCAT gift.com to download. I hope you enjoyed today's podcast and everything we offered. I hope you learned something. And I hope you join us next time here at the medical school headquarters. (upbeat music) [BLANK_AUDIO]
