On World Mental Health Day, Almirall’s CMO Dr Volker Koscielny calls for a new approach in dermatology – where well-being matters as much as clinical outcomes
Interview by Isabel O’Brien
As Chief Medical Officer at Almirall, Dr Volker Koscielny guides the company’s medical affairs and innovation strategy, bringing a crucial medical perspective to both R&D and commercial teams. A trained physician with an MBA from the University of Durham, he has held senior roles at Celgene, GSK, Pfizer, Servier and Boehringer Ingelheim, combining clinical expertise with a rich understanding of the industry.
What drives him most is “the chance to make a meaningful impact on patients’ lives”, especially for those with skin conditions that affect not just their appearance, but their social lives, mental health and day-to-day quality of life. “Communicating that impact is a daily challenge,” he says, “but it’s one that keeps me engaged and energised.”
Speaking from Almirall’s HQ in Barcelona, he laughs about his days being full of “meetings and more meetings”, but for someone who loves “talking to people, getting different perspectives and learning from them”, that suits him perfectly.
In this conversation, he opens up about the often-overlooked mental health impact of skin conditions, what real-world studies have taught him and how dermatology can better support patients – and the people around them.
What sparked your initial interest in healthcare, and what influenced your move from medicine to the pharmaceutical sector?
I’ve always been interested in people. When I started my civil service in Germany, I worked as a nurse in psychiatry – in a psychiatric hospital – and continued doing that throughout my medical studies. It really grounded me and gave me a lot of insight and compassion for people. That experience motivated my desire to study medicine and try to make a contribution somehow.
Later, the move from clinical medicine into the pharmaceutical industry came quite naturally, though it wasn’t planned. When I followed my wife to South Africa, I wasn’t able to work there as a doctor, and that’s when I was offered the chance to join the industry. I immediately loved it – the international dimension, the research, the collaboration with academia around the world. I realised you can also make a real contribution outside the clinic, through science and innovation. Do I miss medicine? Yes – the patient contact, absolutely. But I’ve never regretted the move.
Can we give people their lives back – to a state that resembles a normal, fulfilled life?
Many skin conditions take a hidden toll on mental health, yet it’s often overlooked. How serious is this challenge and what would you say to anyone who thinks it’s “not that important”?
There’s a general perception out there, not helped by the focus on cosmetic interventions, that dermatology isn’t serious. In many ways, dermatology has got a bad press. What people often don’t realise is that many dermatological conditions have a very severe impact on patients – not only on them but on their families and their whole environment.
Take acne, for example. People might say, “It’s just a few spots”. But for teenagers suffering from severe acne, particularly in the age of social media, the impact is profound – on self-esteem, confidence and the person they become. It affects academic performance, the ability to form meaningful relationships, even romantic ones.
And that’s just acne. Think about conditions like psoriasis. The impact is huge. Psoriasis isn’t just a disease of the skin – it’s painful, it causes fatigue, it affects the scalp and the nails. Even someone with limited visible symptoms might have severe nail disease. Imagine a flight attendant with that – their quality of life would be severely affected.
In the context of World Mental Health Day, this is especially significant. It’s not just a momentary issue; the impact builds over time, and it can deeply affect mental well-being if left unaddressed. Our job [in pharma] is to build understanding, communicate this impact and make sure people have access to appropriate care.
Almirall’s POSITIVE real-world study on psoriasis combined traditional clinical outcomes with the WHO-5 Well-Being Index. Could you tell us what the WHO-5 measures and what the study revealed?
Traditionally, in every disease area, we measure improvement in quality of life. What we did here was to pioneer a holistic approach – POSITIVE is the first dermatology study to include the WHO‑5 Well‑Being Index as a primary endpoint – and ask a more radical question: can we give people their lives back, to a state that resembles a normal, fulfilled life?
The WHO-5 Well-Being Index measures mental well-being through five questions – things like, “Do I feel energised?” or “Do I feel vigorous?” It struck us as a very good way to contextualise well-being against the general population and see if patients truly regain their quality of life.
What we found was remarkable. The patients with psoriasis had well-being scores as low as people with diabetes or breast cancer. But after four to six months of treatment, we could show that they returned to normal population levels of well-being. After two years, the results showed a score uplift from 53.7 at baseline to 70.43, surpassing the European population average.
Looking beyond individual patients, how did these findings shape your understanding of the broader impact on families and the way medicines deliver value in the real world?
When developing new medicines, we must meet regulatory endpoints – that’s necessary. But in the real world, we need to explore how much value a medicine really brings to patients living with multiple conditions, in more complex settings.
To do that, we have to go beyond traditional measures. For example, we also look at the impact on the family – the parents who can’t sleep because their child has atopic dermatitis, the strain it places on their work and relationships.
If we want to describe the true value of medicines, we need to look holistically – at patients and their ecosystems. We haven’t always been good at that, but we’re improving. With the help of clinicians and researchers, we’re building a much more accurate picture of both the suffering and the benefits these interventions bring.
We’re now even exploring new concepts, like whether patients with atopic dermatitis can “fall in love with their skin again”. Ultimately, that’s what you want, not just to remove inflammation, but for people to accept, like and feel comfortable in their skin again.
How do you maintain your own well-being, and what do you see as the key to fostering a healthy, positive team culture?
That’s a big question. I wish I could say I’m great at it – sometimes I succeed, sometimes I don’t.
One thing I’ve learned is that it’s essential to surround yourself with positive people. When you build teams, you need people who are aligned on purpose and who share a sense of humour. Humour is extremely important – you have to be able to laugh together and see the absurdities for what they are. In any organisation, you encounter plenty of those!
Working long hours isn’t the issue; the issue is when you internalise everything. If you can’t share or laugh about it, that’s when it becomes unhealthy. I’m fortunate that at Almirall, we’re building a culture of openness and well-being – one where people can have perspective and joy in their work.
On a personal level, you need something that gives you balance, nature, sport, art, music, whatever works for you. For me, it’s nature. Being outside, walking, swimming in the sea – that’s good for the soul. We’re lucky in Barcelona; I can just hop into the Mediterranean and go for a swim. That helps enormously.
Ultimately, it’s not just about removing inflammation, but for people to accept, like and feel comfortable in their skin again
If you could wave a wand and change one thing about healthcare tomorrow, what would it be, and why?
Something close to home for us – and for dermatology – would be to have a robust discussion about what constitutes value in healthcare. As societies, we need to talk about what we’re willing to pay for and what outcomes we truly value. With aging populations and high end-of-life costs for conditions like dementia or cancer that discussion is unavoidable.
For example, take acne. An adolescent who can’t live a fulfilled life because of their acne – who’s only half the person they could be – that’s not life-threatening, but it’s life-limiting. Is that worth paying for? I think so. We need a serious, inclusive dialogue among all stakeholders about value, outcomes and fairness in healthcare. That’s the conversation I’d like to see us have.
