I have been at 3 Fortune 500 companies with various leaders. I can honestly say, since the departure of Mike Exton the culture and level of professionalism has greatly diminished. All things aside, CV leadership has ultimately dictated the falling level of achievement, autonomy and cultivation within the CV division. Since the debauchery on stage by Duane, this sales force will never follow him again and he has lost all credibility and respect. If the sales force is being dismantled and organized, I would be the first to advocate for leadership positions to follow suit. I have never witnessed a more lackluster panel of folks who are so out of tune with their sales force and customer base. I have also never seen a product launch so poorly based on accusation (even with an added year to figure it out). I have NEVER had a clinician question the clinical efficacy or either Leqvio or Entresto. The core issue is the layer and layers of “account folks” (thank god they finally figured out the ADSOCs were only in the way and taking credit for the work by the field), as well as lacking of charisma and direction from above. Novartis is always trying to reinvent the wheel. Simply emulate what currently works in a buy-and-bill schematic and adjust as necessary. If I had a vote, Duane would be the first individual to shoulder the failure of leqvio over the last year and shame on him/others for telling themselves the sales force isn’t getting it done because of call volume, lack of coordination with PSS and fighting for scripts with PCP. If you want a winning culture and division, we need a strong, inspirational and charismatic leader who fully understands the market and sales force. We need fewer layers and more autonomy. We need additional strong CV reps, not PCP reps and a thrown-together field.