Sanofi (SAN) Earnings Call Transcript & Summary
June 9, 2021
Earnings Call Speaker Segments
Keyur Parekh
analystGood afternoon, and good evening, and thank you all for joining us. My name is Keyur Parekh, and I cover Sanofi for Goldman Sachs. It is my distinct honor and privilege to welcome John Reed for this fireside chat. John, thank you very much for joining us.
John Reed
executiveGreat to be here, Keyur.
Keyur Parekh
analystAs most of you know, John is Executive Vice President and Head of R&D for Sanofi. And I believe, John, this is your first kind of Goldman Sachs conference. And it's a shame that we're doing this virtually and not in person at [ Terranea ]. But hopefully, we will resolve that soon enough.
John Reed
executiveNo, it's great to be here. Thanks for the opportunity. I look forward to having this chat with you, Keyur.
Keyur Parekh
analystExcellent, John. John, so I'm going to try and split this chart into kind of 2 different sections. First, I want to talk a few about kind of big picture R&D questions with you, Sanofi, the industry more broadly and then try and discuss a few kind of individual assets and programs. But I don't know if you want to make a few interim comments. You took over as kind of head of Sanofi R&D in 2018, you're coming up to about 3 years on that. So I don't know if you want to make a few opening remarks, and then we'll go to Q&A after that, John.
John Reed
executiveThanks for the opportunity, Keyur. Indeed, been about 3 years now with Sanofi, and really pleased with the progress our team has made in our ambitions around reshaping the pipeline and really remolding the organization from the standpoint of culture, productivity, ways of working, et cetera. We set a broad agenda to reinvigorate Sanofi R&D. We used a framework we call the 4 Ps of pipeline, pace, patients and people, with agenda topics under each of those. And then when Paul Hudson came, he added a 5th P of what he calls play to win, which, frankly, is a lot about prioritizing and deciding really where you're going to double-down and make an attempt to really lead, not spreading one's efforts too broadly. And really pleased with the progress we've made. We set ambitions around pipeline reshaping that included really having a more innovative pipeline with more of our investments in first or best-in-class medicines and went from roughly half of our investments back in that time to now more than 80%. We set ambitions to focus more on specialty care and did ultimately make the decision to get -- entirely exit primary care, and we've really built strong momentum in our pipeline in areas like oncology, where we've gone from 5 molecules in development to 17; in immunology, where we went from 6 molecules in development to 16; in hematology, where we went from 1 molecule in development to 9, while maintaining pretty much steady our rare disease and neurology efforts. And then we've also made great progress in building a more diverse platform of research tools, drug discovery tools that was part of our ambition to be more confident in the area of biologics, and that's reflected in our portfolio now. So the progress has been really, I think, it, frankly, has exceeded my expectations in terms of how quickly we've managed to reshape the pipeline. We've managed to do all this on a -- basically a flat budget. We've absorbed 7 bolt-on acquisitions through reprioritizing where we allocate resources and managed to keep fixed costs actually reduced by 3% during all this. And so we're really positioned now for investing in the pipeline and seeing its full promise brought to fruition.
Keyur Parekh
analystJohn, thank you very much for those introductory comments. Let me start off with a couple of very big picture question. As the head of a global kind of biopharma R&D organization, how do you define success for yourself and for the organization? Kind of, I know people have number of assets, people talk about number of molecules progressing through Phase I, II, III, et cetera. But what is it that you define success for your organization kind of on a tangible basis?
John Reed
executiveWell, I guess, fundamentally, it's about delivering medicines that really elevate the standard of care and serve unmet needs and doing that with an efficiency and a cost effectiveness that's industry competitive. And you can run portfolio simulations on that depending on how much you invest versus how much you deliver. We've been through quite a journey at Sanofi to improve productivity. We knew that, that was a weak spot in the past. And we've really come a long way. The productivity from our own labs now is fully at industry competitive levels in terms of both cost effectiveness and cycle times to deliver development candidates. We're now actually slightly exceeding the industry averages on that after years of very lackluster productivity from our own labs. So we feel very confident about that. Saving and development where, now, cycle times and cost effectiveness are industry competitive, leading in some areas. Lagging a little bit and others, but very competitive. And we've been through a process we're really setting up in a more efficient way the organization from a diversity of sites that all did a little bit of everything to a much more efficient, what we call, centers of excellence model where we're avoiding the historical precedence of the past where we had a lot of duplication, triplication, quadruplicated of capabilities around the globe to really a much more a network of capabilities based around centers of excellence concept that is helping. So I think altogether, progress is good there and will help us to have a sustainable pipeline that delivers at a cost effectiveness that is industry competitive.
Keyur Parekh
analystSo John, you spoke on a few things like kind of productivity, cost effectiveness, which a lot of us think about this kind of in terms of financial returns or make rates. So if you were to think about kind of success in terms of numbers, would you think about in terms of kind of returns on your R&D investments, IRRs? Kind of what is the right kind of financial metrics you look at?
John Reed
executiveYes. I mean we -- what we often use as the main indicator is a productivity index, which would be the adjusted NPV of the portfolio versus the risk-adjusted cost going forward. And that's a metric that we use on every molecule and then aggregate up to the portfolio is at least one way -- is one lens. There's never any perfect lens because that doesn't necessarily capture all the elements of innovation or medical impact. But for more of a financial kind of lens, it's a metric that we like to use for decision-making. And we have certain criteria like if a project comes for governance for decisions, if it doesn't have a productivity index above a certain level, then we need to have a really strong rationale for why it should be invested in. And we've really cleaned up the portfolio a lot in terms of that. We had multiple projects that didn't meet that criteria, and I won't say exactly what it is. But in the past, we're -- now we have 3 or 4, and that's because there's some strong strategic rationale behind it. So -- in fact, using that metric, we've almost doubled the productivity, the productivity of the pipeline in the last 4 years.
Keyur Parekh
analystAnd I guess you can refer to this as well, which is kind of historically has not been, at least from an investor perspective, the strong suit for Sanofi, you've just said you've doubled that. So can you throw some numbers around it? Are we talking about kind of whether it's returns going from low single digits to mid-single digits today, and where do you aim to be on that front? But can you just help us conceptually think about what is it that Sanofi R&D should return over the next few years?
John Reed
executiveYes. I don't know -- I don't think we've given guidance specifically on that. But I guess there are other sort of intermediate points where we look for generating a certain number of first-in-human studies per year, a certain number of POCs, things like that, that we use as metrics of a sustainable pipeline that's generating a couple of NMEs every year that have blockbuster potential. So -- but I don't think we've given specific guidance on that, but those are ways that we internally think about the portfolio and whether we're delivering with a productivity that will allow for a sustainable pipeline.
Keyur Parekh
analystWhat do you see as the key kind of determinants of success for R&D in an organization? And how have you kind of tangibly changed the organization over the last 3 years to achieve that success?
John Reed
executiveYes. Well, I think there can be a number of things, and I have various paradigms that I use, but I might invoke, for example, the 6 Ts of talent, teamwork, tenacity, technology, truth-seeking and time lines as an example of some of the components of that. Certainly, talent is first and foremost, having really the right people in the right roles. And then empowering that talent, the teamwork that goes with the parts of the organization all working together. We've done a lot of work to reach -- frankly, to reach -- to change the organization in Sanofi R&D to allow for faster decision-making for more accountability. We had a very complex matrix setup, for example, that on the one hand, provided a lot of checks and balances, but on the other hand, it diluted accountability and responsibility and ownership and it made decision-making very slow. So we've linearized almost every component of Sanofi R&D so that there's clear accountability and responsibility, and we've done a lot with empowering teams and pushing decision-making and stripping away committees that used to exist and things like this. And then there's sort of the, what I call, the tenacity thing, which is building a culture that really cares about the urgency of delivering with a pace that patients would be proud of, and really going the extra mile to deliver for patients. So those are some of the things. Technology is an important part, and that's where, in addition to all the things going on with digital and data, scale, real-world evidence, et cetera, that's for us in research it's been building access to platforms, gene therapy mRNA therapeutics, nanobodies, antibody drug conjugates, synthetic biology, all the ways and molecules will be made in the future. And then time line is about execution. And there, our efforts to really pick up the pace at Sanofi have been paying off, and we're now really firing on all cylinders when it comes to that. So those are dimensions to it. And then the final thing I mentioned is truth-seeking, which is really having objective, rigorous review of what investment decisions you're going to make, when you're going to double down, when you're going to cut your losses and move on. And so really promoting that truth-seeking culture is critical as well. So I see those 6 Ts of talent, teamwork, tenacity, technology, time lines and truth-seeking as being sort of a framework for successful R&D organizations.
Keyur Parekh
analystSo there's widespread investor perception. I think if you look at kind of studies kind of over the last 10, 15 years, there's consistent data to suggest that R&D productivity kind of has been on a steady and slow, if not spectacular decline over the last decade. If I look at industry valuations today, to me, what's implied is return on R&D kind of meaningfully below cost of capital, maybe even less than half of the cost of capital for the industry as a whole. Certainly, for Sanofi, that seems to be the case as to what investors are implying in the current valuation. What do you think has gone wrong with the industry over the last decade? And what do you think the outlook for this is, specifically for Sanofi, but also your views on the industry would be great.
John Reed
executiveWell, I think there can be a number of things that "go wrong". I would say that putting a lot of resources into what I would call me-too medicines is not a good use of capital, although it's been certainly one of the sins that many of our companies have been guilty. I think also frequent shifts of strategic direction mean that one often doesn't have the opportunity to reap the investments that have been made. And there could be good reasons for those, but those are also things that certainly hurt productivity. But at the other hand, I would say there's a lot to be hopeful about as well. Certainly, digital and big data are certainly elements of that and everything digital and being able to automate, improve efficiency, drive down costs, improve pace is certainly a journey that the whole industry is on and that I think is going to make a big impact. I think we'd also be excited about the new platforms for drug discovery that have been progressively becoming validated. Things like the first bispecific antibodies have now been approved. The first nanobody has been approved. Gene therapies, cell therapies, particularly CAR-T, siRNAs, mRNAs now with the vaccines, even things like maybe using antisense oligonucleotides for CNS diseases are things that opened up new opportunity spaces that didn't exist before. So there's a lot to be excited about, I think, in terms of platforms. And then I think there are certain deals of science that suddenly -- seemingly suddenly bust open with new opportunity, and you could probably say that about human immunology. What an incredible ride the industry has been on in the area of immunology, both for autoimmune and inflammatory diseases and now, for cancer in terms of fighting cancer with immunotherapies. I mean it's really impressive to think that we now have antibody drugs to IL-1, IL-4, IL-5, IL-6, IL-13, IL-17, IL-23, I mean it just goes on and on. And there's so much exciting happening in the area of immuno-oncology, first with checkpoint inhibitors, but then bispecific T-cell engagers, lymphokines, CAR-Ts and so much more coming. So it's -- there are reasons, I think, for hope that we'll see renewed productivity across the industry.
Keyur Parekh
analystJohn, I've got one last question on the big picture, and then we'll move to individual assets. The -- I think kind of most people agree that the funding environment for biotech has never kind of been better or stronger. And any data set you look at kind of seems to suggest that the quantum of capital available is almost kind of there's no limit to it. It's almost infinite. What are some of the opportunities and challenges that this funding environment creates for kind of the head of a large-cap biopharma R&D organization?
John Reed
executiveYes. It's -- I totally agree that it's -- I mean the whole sector is just flushed with cash. And you can see that with the SPAC movement now where people have so much money they deploy that they just put it in a vehicle and say, please go out and find something interesting to buy in this space. There are pros and cons for our world. On the pro side. It's just great. There is so much activity. There is so much investment in innovation, and that means there'll be a plethora of opportunities for either easy development partnering or for M&A down the road. And so it's just great to see more and more activity. The con side, I think, is felt probably the most on retaining talent because the opportunity is so vibrant now in biotech, it becomes an attractive option for some of our best talent to go take a tour of duty in the biotech environment and leave large pharma. So I think that's probably the main trade-off that we're facing. Maybe the other, too, is that the -- because companies are so well funded now rather than the kind of nickel and dime kind of funding that used to be the case, these biotech companies tend to be less dependent on big pharma in their early journeys with the molecules. And so they -- it means that you're not going to maybe get an access to it. The companies won't be willing or ready to partner until later. And so the value inflection, of course, will have occurred and so, their prices will also be higher. Not necessarily a bad thing. Maybe you can say you get what you pay for, but it does change that dynamic as well quite considerably.
Keyur Parekh
analystJohn, thank you for that. Now I'm going to move to all the individual assets, and I add ASCO, and obviously, you all heard the presentation on Friday, but I want to start with kind of your SERD, which obviously is a lot of interest to people. Would love to hear your thoughts on how you think amcenestrant is different to the multiple other SERDs in development kind of as we look at the upcoming data for AMEERA-3, kind of what do you think defines clinical success and commercial success? And are those different?
John Reed
executiveYes. So we're -- yes, we featured amcenestrant, our oral SERD, at ASCO is one of the flagship molecules in Sanofi's return to oncology. We believe we have a best-in-class profile with the molecule. Several of the molecules in the space, we would argue, are pretty similar in terms of efficacy, but we have what appears to be the most pristine safety and tolerability profile. And that really matters in early lines of treatment, particularly in the adjuvant space, where patients are on drug for years and where tolerability really matters. And of course, that's the biggest market opportunity as well. So we're excited about the profile we have. We attribute it to the difference in our chemical structures relative to the competitors that have seen problems with cardiac toxicity and bradycardia and QT prolongation or have seen ocular vision disturbances and other non-mechanism-based activities that we can -- our chemists can ascribe to structural differences in our molecules. We have a -- with amcenestrant a very well-behaved molecule, a single once-a-day oral that it does a great job of degrading and blocking the estrogen receptor for what we think will be a very competitive efficacy in this space. The data we presented at ASCO gave another peak at those data with the -- looking at patients in combination with palbociclib, the CDK4 inhibitor, and showing a very competitive overall response rate of 34% and a clinical benefit rate of 74%. That's a small number of patients, and it really -- different studies have different prior treatments in terms of what the patients have already been exposed to and that really matters. But altogether, as best we can benchmark it against other data, that should be a very competitive profile with a best-in-class tolerability profile that allow us to really move into that early lines of breast cancer.
Keyur Parekh
analystAs we look at kind of AMEERA-3, and I'm kind of pushing you here, but what should be of a base case? Should it be superiority to standard of care? Should it be kind of non-inferiority from an efficacy perspective with the convenience of an oral agent versus intramuscular? How -- what do you think kind of would be the outcome?
John Reed
executiveWell, I don't like to overpromise and underdeliver, so I would say that if we even show comparability to standard of care, I think that's going to be noteworthy. And the reason I say that is that the study is designed -- these are patients who've already failed frontline therapy. They're second line, some are third line. Most of them would have already seen a CDK4/6 inhibitor and other hormonal agents. And the investigators can choose what hormonal therapy to use. And our intelligence is telling us that most of them are choosing fulvestrant, the IM SERD, intramuscular SERD. So I think our study is going to more or less amount to a head-to-head of an intramuscular SERD against -- versus an oral SERD in this second, third line group of patients. So if we can show that we're at least as good as that, I think that's something to be said. Of course, we're hoping for superiority, and that's -- we've tried to power the study in a way that we think that's possible to show. The study is event-driven, and the time lines keep stretching out because we haven't achieved enough events in terms of progression-free survival, which may be a good sign. If those -- if they tell you those events are occurring disproportionately in the amcenestrant arm. But it's a relatively high bar for a study to get some randomized data and kind of set a benchmark for the molecule that will, I think, help guide our future decision-making.
Keyur Parekh
analystAnd do you think kind of a non-inferiority with a dosing kind of convenience would be enough from a commercial perspective or would give you enough confidence to devote resources in the adjuvant studies that you just announced?
John Reed
executiveYes. I mean we've made the decision to move into these earlier line of therapy, regardless. I think it would take a poor showing of inferiority to the standard of care for us to change our mind because really, the place where this mechanism should shine is, frankly, in that early lines of breast cancer, like in the adjuvant space where patients have not already seen CDK4/6 inhibitors, for example, and where this should be a best-in-class solution for addressing a hormonal estrogen receptor-driven growth in survival mechanism for the breast cancer. So we think that is the place where, frankly, we have the highest probability of success would be in that adjuvant space. So barring some catastrophic readout with AMEERA-3 that would suggest inferiority, we're -- I suspect we'll be committed to doing that.
Keyur Parekh
analystJohn, given in the earlier lines this drug will likely be used in combination with some form of a CDK4/6. Kind of can you combine the 2 molecules? Is that something kind of from a life cycle management perspective you're thinking of?
John Reed
executiveWell, we are doing that already in the first-line metastatic setting with AMEERA-5, which is palbociclib combined with our oral SERD, amcenestrant, versus palbociclib combined with an aromatase inhibitor. And so we're going to try to succeed there where fulvestrant failed in that first-line setting of metastatic breast cancer based on what we think is going to be better efficacy that combines -- well, we showed the combinability in the data we showed at ASCO, from a safety perspective, no new treatment-related adverse events. We still believe we have the most tolerated SERD, oral SERD out there. So that study is underway, and it's actually enrolling ahead of schedule, a lot of investigator enthusiasm for that. Now down the road, we might do adjuvant studies that would include a CDK4/6 inhibitor in a high-risk population. We're cogitating around some of those opportunities, but haven't made a decision on that yet.
Keyur Parekh
analystJohn, moving away from the sort of -- kind of one of the good positive surprises a few weeks back was nirsevimab map kind of I think we're expecting the data until much later. So I know that data is not published. But what can you tell us about kind of your excitement around the data set? What should we kind of interpret from the trial stopping at interim there?
John Reed
executiveYes. So for those who aren't as familiar, nirsevimab is the anti-RSV antibody that's really being used in lieu of a vaccination for infants. RSV pneumonia is the leading cause of hospitalization of infants around the world, a great public health burden. And the problem is that these infants -- their immune system is not mature enough to really defend themselves. And so we're doing it for them with a monoclonal antibody that has Fc engineering to give very long pharmacology. So it's a single dose, lasts for about 5 months to protect the infant through the RSV season and into the winter months. And the proposition here is to have a protection for every infant in their first year of life. And then you could also consider it into subsequent years for patients that have underlying medical conditions. And the data we've achieved so far have really validated that approach in terms of reducing RSV-confirmed pneumonia, lower respiratory tract infections and hospitalizations. We had hoped to do a larger study than what we're relying on now. But because of social distancing, the incidence of RSV has really gone down and so in discussions with health authorities, they agreed we could use the data we have now for the efficacy part. They do want us, from a safety standpoint, just to collect data on more patients simply to show safety. But we feel that once we've collected those data, we'll have the full package needed for regulatory approvals and look forward to making that subcu single injection available in a -- as a passive immunity strategy now for what is a really huge public health burden of RSV pneumonia and hospitalization.
Keyur Parekh
analystAnd kind of given the lower number of events, which is kind of very understandable, how comfortable do you feel that once you might -- you will clearly kind of phone regulators, you feel comfortable about the regulatory side of it. But from a payer perspective, do you think those number of events are going to be enough to convince people to reimburse this medicine?
John Reed
executiveIt's always the unknown question is the dialogue. But it's clear from a medical economic standpoint that RSV pneumonia and hospitalizations is a very common problem. It's a burden on health care systems, and I -- we're going to price this like a vaccine, not like a therapeutic. So I think there's a strong case to be made there. And we hope that sensible discussions will unfold with the payers around the world in that regard. So to be determined, but we're cautiously optimistic.
Keyur Parekh
analystJohn, moving on to tolebrutinib kind of how important do you think the brain-penetrant part of this medicine actually is relative to the disease? Kind of how relevant do you think that is going to be compared to some of the other BTKs in development?
John Reed
executiveRight. Well, we think it's very important for preventing the smoldering long-term chronic inflammation that really describes MS today where there's, despite some very effective therapies that prevent flares, patients still, over time, have cumulative disability. And of course, this is most clearly manifested in the progressive forms, the primary and the secondary progressive MS, where we don't have much to offer patients right now. So the hypothesis behind is this is inflammation behind the blood-brain barrier. It can involve, in particular, the microglial cells, which are macrophage-like cells in some ways that reside in the brain. It can also involve nests of lymphocytes that get behind the blood-brain barrier and create persistent pockets of inflammation by virtue of being able to cross the blood-brain barrier unlike other BTK inhibitors and many other molecules in this space. We're hopeful that we can make a dent there where others that say, "Oh, we know we do get target engagement in the brain." We're doing a number of very sophisticated MRI studies to assess microglial activity in patients that will provide some kind of pharmacodynamic biomarker types of data while we're collecting the data on clinical endpoints on the ongoing Phase III programs. We have 4 Phase III studies underway, 2 in relapsing-remitting where this should be a slam dunk as a highly, highly effective oral therapy. And then 1 in secondary progressive, and 1 in primary progressive MS. So really covering the broad landscape. But that was really our thesis going into the brain penetration matters. And for the reasons I said, so we're really bullish on this mechanism in tolebrutinib.
Keyur Parekh
analystSo just to be clear, you would expect an efficacy differential between a brain-penetrant BTK versus a non-brain-penetrant BTK in this setting. Is that kind of as...
John Reed
executiveAbsolutely. So BTK, just getting into a little bit of the science, 2 places where it plays really important roles, not the only places, but in the B-cells, downstream of the B-cell antigen receptor, that's how you kind of get a B-cell started in terms of causing this shift. And so BTK is essential for that mechanism. And molecules that work in the periphery do a pretty good job of squelching that. But then it also plays an important role downstream with things like Fc receptors, which are what the microglia, for example, express, and that single transaction mechanism, again, is dependent on BTK. And if you don't have a brain-penetrant molecule, you're not doing anything about that. So those Fc receptors bind immunoglobulins and signal into microglia and into other types of inflammatory cells. And so that piece of the BTK biology in the context of MS, we think, it's really important that you have brain penetration. And other molecules in this space don't have it.
Keyur Parekh
analystJohn, we're coming up to the last kind of 5 minutes of this chat. And I guess one of the questions I get asked or have been asked most over the last kind of 18 months for obvious reasons is mRNA and kind of either the opportunity for companies like Sanofi to benefit from the modality versus kind of the threat of mRNA as a modality to some of your existing kind of vaccine franchises. How do you process that? And how do you kind of think about one versus the other?
John Reed
executiveYes. Well, indeed, I think the marvelous thing about the success with the mRNA vaccines is it's really opened up -- it's valleyed a whole new approach to vaccinology that didn't exist before that was more hypothetical. And so I think it is one of those transformational moments for the whole vaccine field, and my colleagues at Sanofi Pasteur and the vaccines division feel the same way. We envision massive shifts in our portfolio over time where probably over half our vaccine candidates in the future will be mRNAs, I would guess. Fortunately, we started collaboration with Translate Bio back in 2018, which included not just starting some programs on RNA vaccines against certain pathogens, but a whole tech transfer. And in fact, they've just received their milestone payment for the successful first phase of that. So we had already planned to really establish that capability in-house. And so this just motivates us more to accelerate it and to expand it. And so that will be the journey. We're in the clinic with our COVID mRNA and soon with the flu -- influenza mRNA as we're beginning to -- our adventure at Sanofi with the vaccines with the mRNA space. Prior to the field being validated, of course, we were not throwing such large resource at it or really prioritizing it. But now that that field is validated, that's exactly what we're doing. So we're -- actively, the colleagues are in the process of deprioritizing other things so they can put the resources there and really accelerating that whole tech transfer and making a commitment to grow in this space. I would say also on the therapeutics side, while mRNA is not yet validated there, we are also working in that space. We have a nifty collaboration with Sangamo, for example, using mRNAs in coding genome-editing enzymes where we modify the genome of hematopoietic stem cells ex vivo using that technology. We're also using mRNA for genome editing of NK cells, natural killer cells. For immuno-oncology, having recently acquired Kiadis as a universal allogeneic NK cell platform and have many aspirations around genome editing there using mRNAs encoding genome-editing enzymes. And then we recently acquired a small but exciting company called Tidal Therapeutics that has a nanoparticle technology for delivering mRNA cargoes to specific types of cells or tissues. And the first iteration of that is we're actually doing CAR-T-cells in the body rather than through all the elaborate genetic engineering of the stem now where one has a lipid nanoparticle inside, which is an mRNA encoding the CAR, the chimeric antigen receptor, and then conjugate to the lipids or antibody fragments that bind to T-cells and then deliver that into the T-cells. So we have several efforts underway. And together with Pasteur envision creating this core competencies around the mRNA platform, which we'll pursue, certainly, for vaccines and hopefully, more and more in therapeutics as well.
Keyur Parekh
analystJohn, I've got 2 last quick questions for you. I'm not going to ask you to comment on what you think of the approval for aducanumab kind of this week but perhaps your perspective on what does the FDA, the agency's willingness to approve something on an accelerated basis, what does that mean to you as ahead of R&D? And what does it mean to your willingness to take risk on such assets?
John Reed
executiveWell, I think it could be interpreted to be either good or bad, depending on maybe on what hat you're wearing. If you're maybe a head of R&D and thinking about getting molecules on to market, it could be good. A lot of it really depends on how confident are you in the surrogate biomarkers that have been used for these approvals. And I would say in the case of amyloid, the confidence level at this point is not terribly high given all the evidence that has set a disconnect between those. I would say maybe one ray of hope I saw in the data is it looked like tau levels were also decreased. And so maybe through other mechanisms, you're also decreasing tau and people think maybe that is closer to the real driver of the cognitive impairment. But again, many unknowns. I think that's kind of the upside. I mean we saw the same kind of thing happen with the oligonucleotide therapies for muscular dystrophy, where they were approved basically on biomarker data with not as robust clinical data as one would have liked to see. On the other side, I think it's going to be the conversations with access and payers and what should society pay for medicines that maybe have not yet reached that higher bar of showing irrefutable clinical evidence. That's going to be a difficult conversation that could spread ripples into the industry that may be poisonous at some level. So I worry about that part of the conversation.
Keyur Parekh
analystJohn, with that, the last question. As an American, as you look at Euros 2020 coming up, do you support [ Jaybee ] in France? Or do you root for [ Paul ] in England?
John Reed
executiveOh boy, that's a loaded tough question there. I'm hoping for one of those classic tie games. 0 to 0, how about that?
Keyur Parekh
analystWith that fall, we've come to the time. So thank you very much for your time and thoughts. I really appreciate it. And thank you all for joining. Have a good rest of the day, and enjoy the conference. Thank you again.
John Reed
executiveThank you.
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