Daniel Skovronsky made Eli Lilly the most valuable drug company by market cap (Sep 2023). His company was acquired by Lilly and within 8 years he became Lilly’s CSO. He took brave bets in areas no one was willing to go for patients—and he won.

Here are eight principles from Dan Skovronsky’s leadership playbook:

1. Work on something really hard for a long time.

Skovronsky was at home when he got a call from Lilly’s statisticians informing him that their drug was effective. Donanemab could slow the progression of Alzheimer’s by 35%.

“Any words I use to describe my emotions at seeing the data will fall short. I’ve been pursuing the same enemy for 25 years. I was a kid when I started at this. Working on something hard for a long time and seeing it come to some meaningful fruition is hugely rewarding”.

“Now I want to make sure that my employees have this kind of experience: Work on really hard problems for a long time, slowly building up the scientific evidence until we can make meaningful drugs, and then, do bold trials and see the results.”

2. Want to create change? Be bold and critical.

“One reason he succeeded, he believes, is that he was willing to be critical because he already had success. (Skovronsky joined Lilly in 2010 when Lilly bought his company Avid Radiopharmaceuticals for $300m.)

That made him bold, he said, and led him to point out how slowly Lilly moved in developing new medicines. Lilly executives responded by offering him a role as the company’s vice president of target therapeutics.

Over time, his complaints would have an impact: Since 2014, the time it takes for new medicines at Lilly to go from starting clinical trials to approval went from 11.5 years to 6. Within two years, he was promoted to SVP for product development and within eight years to CSO.”

3. Marry the best of both worlds, biotech and pharma.

What’s incredible about pharma is the resources, the people, the money—and the stability and continuity of that—which leads to institutional learning, investing in functional know-how, and the development of expertise.

What’s incredible about biotech is the conviction, a sink-or-swim around a conviction, an asset, a technology or an idea. The focus that comes with that conviction is hugely valuable. The inadequate resources force you to focus on the best opportunities.

Because you have no stability in biotech, you sweat the small and the big stuff. There’s personal involvement from the leaders because their lives are at stake. And that’s why everyone is involved in the details of clinical trials, regulatory affairs, discovery, strategy, etc.

What I’ve tried to do at Lilly—and I’m still not fully successful—is to marry the best of both worlds: within the walls of a large pharmaceutical company, with all the resources, create smaller groups that look like biotechs.

We have companies that we have acquired over the years—including the company that I came from 10 years ago—that still exist as biotech companies within our walls operating in the same way as they did before.

The biggest of those companies is Loxo Oncology. What we did with Loxo was, not only did we bring them in and say, keep doing what you’re doing, but we gave them the rest of our oncology portfolio and said, now run our portfolio the same way! 

What I’ve tried to do over the years is to abolish as many committees as possible and dismantle the bureaucracy that pharma companies usually rely on. We set up the molecules in our portfolio as little companies and each one of those companies has a leadership team and board of directors. And they’ll meet whenever they need to—and that’s the way we provide the governance instead of the teams coming to committees for approvals.

The teams love it, people find it so satisfying, and decision-making is faster. The leaders of the various functions/committees—who you might guess would be opposed—tell me, “I love being on the boards of these companies within Lilly, I’m engaged and close to the projects, it’s fun!”

4. What motivates people is not the rewards but their personal impact on the work.

“When we think about biotech, people usually jump to the asymmetry and the outsized financial rewards for risk-taking, but I haven’t found that to be the real problem.

It’s all about being able to see your personal impact on the work—and that’s the valuable thing about biotech that you have to create in a big pharma company. People have to see how their work matters, how it impacts the project, how they’re making a difference.”

5. Delegation becomes easy when you have the right people.

“Giving up power and delegating is not easy; we all struggle with it. That’s why people are the most important ingredient. If you have great people whom you can trust, why would you be uncomfortable delegating to them?

Delegation also becomes easier when you have acquired a biotech company. We paid billions of dollars because we like the decisions these guys have made over the last few years… Well, let them continue to make those decisions and figure it out themselves!”

Whenever people tell me about their best career experiences at Lilly or anywhere, they always say, “I was working on a small team, there was time pressure, it was really important for the company, and it was delegated for us to figure it out—and we did it!”

6. Persevere when everyone else gives up.

In 2016, Lilly’s lead Alzheimer’s drug, solanezumab, failed dramatically and caused a multi-billion-dollar plunge in Lilly’s market value. That was a profound blow to Skovrosky’s hypothesis that targeting amyloid could ever lead to an effective drug.

Major drug companies such as AstraZeneca, Pfizer, BSM, GSK, and Amgen, were giving up on brain drugs. Pfizer closed its neuroscience division and cut 300 jobs.

“Dave Ricks wasn’t yet our CEO at the time but he was running the business unit that controlled that asset. So Dave asked me to do a special project, which was to write up a rationale to show to our board of directors what we would do next if solanezumab failed.

I worked really hard on that, and as a scientist, I dug deep into all the reasons from genetics to mouse models to pathology and biomarkers, why this is the right target, and why we should continue going after it with better and better drugs.

When I showed it to Dave, he said, “This is great, except you forgot the most important reason why we’re not giving up on Alzheimer’s. And I was like, oh no, what is it?

The most important reason, Dave said, is the patients who are suffering. And if we don’t do it, no one else will. He was right…

That’s what it takes in this business. You’ve got to combine a passion for helping patients with deep science. Alzheimer’s is the most feared disease among elderly Americans and the only of the top causes of death that we’ve had no progress over decades, so we couldn’t give up.

Sometimes disease areas become popular, and sometimes they fall out of fashion. For the last ten years, Alzheimer’s was way out of fashion. The strategic thing to do was to stop working in neuroscience. That shows what a great leader you are. We resisted that.”

7. Persevere BUT learn from your mistakes and make smart decisions.

Picking up the pieces, Skovronsky and the team would target only what could be reliably measured in the brain going forward. Drugs would also have to hit their targets hard to advance to later stage development.

They also took another strategic decision to focus on Phase 2 trials rather than rush from early studies to giant Phase 3 trials with thousands of patients as everyone did before in the hope of winning the Alzheimer’s race. Well, at that point, they had no competition anyway!

The fruit of seven more years of perseverance and learning was donanemab—a drug that showed a 35% slowing of Alzheimer’s progress that’s now on its way to FDA approval.

8. Be transparent and thorough—especially when the community is sceptical.

Matthew Herper at STAT News pointed out at the STAT Breakthrough Summit in May 2023 that Skovronsky had put a lot of data in the press release.

Skovronsky said, “There’s so much scepticism in Alzheimer’s because of the history of failure. We didn’t want people to look at the data and say, “Well, they didn’t tell us the secondary or maybe it was just a single analysis method, or we didn’t exactly see the p-values. We didn’t want more controversy in the field. I don’t think that’s helpful for science, and certainly, not helpful for patients.”

Three more things:

1. There’s something else that Dan Skovronksy said during an interview with Mike Rea IDEA Pharma that I found to be thought-provoking and at the same time very humbling:

“We are at this point where we have unlocked the science and we’ve translated that into some powerful medicines. Now… making those medicines into widely available global solutions for hugely important diseases is equally if not more challenging. Probably earlier in my career, I wouldn’t have recognized the challenge of that half of the business.Just creating a medicine and even getting it approved isn’t enough; you’ve got to get it available and accessible to people and make sure it’s used. Developing better drugs is hard but creating a brand new standard of care turns out to be even harder.One of my personal ambitions is that we see more of the innovation culture applied to the commercial side of our business.”

2. Dan Skovronsky wouldn’t have been able to create change and innovation had it not been for the support of Lilly’s CEO David Ricks. Ricks backed Skovronsky in a way that is rare in the industry.

“Dan’s different. I had this sense immediately. Some people get in biotech for the cha-ching…” — Dave Ricks.

3. The point above reminds me of what my good mentor John Maraganore has said, “One person cannot do it alone. Leaders need someone else to help them complete the sentence, close the door they opened, or see around the corner.”