Vignesh Rajah, Medical Director, Wyeth UK

Keeping Mum about telling Dad
Vignesh Rajah, Medical Director at Wyeth recalls the trepidation with which he told his family he was leaving the NHS and joining the pharmaceutical industry.

Six months after he took a job with Aventis, Vignesh Rajah found a quiet moment amidst a bustling Christmas holiday, poured his Father a brandy and explained that he was feeling inspired about medical science once more. Although the Senior Mr Rajah was atavistically pleased to see his son motivated, it took a further three days before congratulation was offered. The reason for the silent stand-off - Vignesh had stepped over a cultural boundary by stepping into a career in the pharmaceutical industry.

In India's traditional culture, being a physician is believed to be 'one of the most graceful and noble professions', with a high attainment of personal-esteem and respect thanks to the perceived selflessness that your 'service' contributes within your community. To a man of Mr Rajah Senior's generation. therefore, (and as a GP himself) moving medicine to the realm of business and commercial gain makes a mockery of such values. Little wonder then that Vignesh found himself in a professional dichotomy; leap out of grace with the personal belief that being in the pharmaceutical industry could facilitate a bigger service to a wider patient population or stay put in and marinate in local favour but always feeling that you had more to contribute?

Vignesh jumped . and the net appeared. And the tipping-point that prompted this leap of faith was realization that 10 years in the NHS, culminating as a Paediatric Intensivist at Great Ormond Street Hospital, had yielded a disappointingly low number of innovative medicines designed for children and no opportunity to develop any in such an innovative inertia. Vignesh recalls that, "I would struggle to think of a single medicine that had been specifically developed for children. Vast majority of treatments were adapted using clinical judgement from adult formulations. It was wholly unscientific. I felt deflated - despairing almost at the lack of pace to develop new medicines, better solutions for these children. This made me reflect on what I was - or rather wasn't contributing - from my initial decision to practice medicine to make some sort of improvement, difference, impact on patient care. And the more I looked around, the more I realized that my scientific aspirations would never be achieved unless I was in a more inspirational setting." Following this self-appraisal, Vignesh embarked on a series of informal interviews and 'personal research' amongst colleagues and friends to determine if there was an alternative path that could reignite his passion for clinical research. The more he spoke to peers who had moved into industry, the more his eyes were opened to the chance that industry provides to let talent flourish. Vignesh explains that, "the whole gamet of what industry can offer, and the passion with which the individuals in industry are motivated to perform to the best of their abilities was thrilling."

Vignesh was compelled to move into industry and that 'service' loss has certainly been to society's gain. His current role is broad. As the Medical Director for Wyeth in the UK, Vignesh oversees large clinical development programmes as well as research into immunotherapy, oncology, haemophilia, anti-infectives and vaccines. He is responsible for patient safety monitoring and provision of medical information, with management of more than 65 people who he believes are the "unsung heroes who take on the challenges of rigorous development and processing of medicines and creating appropriately persuasive business cases to bring them to patients and the public".

It is the invisibility of this remit and these individuals of integrity that continues to frustrate him. Vignesh explains, "when I made my decision to join, the only image of the industry was of the small percentage of the sales representatives within the companies. Where was the profile of the researchers, the chemists, the medics and the developers? Why was there an impression that industry is stuffed to the rafters with sales people rather than scientists? That impression perpetuates. There has been no consistent voice to praise what industry does well and to explain the necessity to commercialize medicine to bring life-changing drugs to fruition. Infact, we have become to used to being criticized. It's crazy. We spend at least 5 years as students being encouraged to think about how to be the best doctor that we can be, yet we neglect to think to parallel that by understanding how to develop the best medicines that our patients need. It is scandalous that there is so little knowledge about the pathway a drug takes or why a company makes certain developmental decisions. We simply must align better with the medical schools and lift this veil of secrecy about the role and value of industry. Maybe it is as simple as having pride within industry about what we do and why."

Perhaps it was that initial practice of keeping Mum about telling Dad - and then eventually earning paternal respect for his decision that has now empowered Vignesh to be more vocal and speak against the mediated conflict between physicians and industry and speak up for industry's contribution to society. "There are gaps and deficiencies in how we defend ourselves and what we do. We should be praised for our focus, innovation and delivery of products. There is still an element of asserting that working as a medic in the industry is not quite so good as working without industry partnerships, but it is only though more collaboration that we can achieve the greater good. Industry takes responsibility for the huge societal burden of disease but gets little credit for its efforts to provide relief for that burden through innovation and product development. But there are bigger questions here that industry must also heed. The burden of chronic disease is soaring, there are increasing mandates by regulators and policy makers, there is a greater need to demonstrate the true value of of innovation, and we need to use industry's resources to mobilize programmes in prevention and healthcare rather than individual drugs . we should be partners to look for disease solutions versus products. But until industry is accepted as an equal and knowledgeable voice in this debate we will just keep circling the issues. We basically need to step down from our ivory towers and listen to what's needed on the shopfloor. If the medical community and the pharmaceutical industry can do that then we will have a win-win situation for patients."

Vignesh is championing the call for elevated engagements with the medical community and enlightened thinking both of and through the industry. This is based on a deep-rooted acceptance of his personal service so eloquently eschewed by his Father as a member of that 'graceful and noble profession' - aligned with his humble authority as a leader in industry. Vignesh wants industry to step away from IP battles and share expertise to keep medicine moving forward. He wants to make sure that industry places much more emphasis on the development of paediatric medicines and solutions for the developing world. Furthermore, he knows that trailblazing will always attract its critics but is courageous enough to continue to let his voice be heard; "I come away from hearing patient's stories [at NICE reviews] and always go back to my original motivation - I need to try a bit harder tomorrow."

With such a vision and such a voice for change, Vignesh need keep Mum no more.