Garth Sundem

Welcome to this episode of the Medical Affairs Professional Society podcast series, Elevate. I’m your host, Garth Sundem, communications director at MAPS. And today we’re talking about patient education strategies for Medical Affairs. Joining us are Tim Mikhelashvili, CEO & Co-Founder, Amedea Pharma, and Riaz Abbas, Learning and Performance Lead, JAPAC Medical, Amgen. Views expressed are those of the presenters and do not reflect endorsement by their organizations. So Medical Affairs is struggling to figure out how to compliantly engage patients. And today we’re talking about one aspect of this this engagement, and that is patient education. So Riaz, I was hoping you could start us out by talking about why patient education is important.

Riaz Abbas

Well, thank you, Garth, and Tim, for having me. To continue our conversation in this podcast series, was my pleasure to be here. And before I start, I must add a disclaimer, Garth that opinions and I’m going to express in views I’m going to share on my own and not off my employer Amgen. Why is patient education important? It’s a really, really relevant and important topic. I believe patients are the ultimate cause ultimate customer or consumer of the medicines and products be developed. And I also strongly feel that as credible and ethical developers of medicines, it’s our responsibility to provide, you know, fair, balanced, accurate information relating to relating to our products to our customers. And I feel more recently in quiet more, it’s becoming more and more upfront that there is a whole, you know, evolution of patient centered health, healthcare, that demands a joint approach from from an HCP perspective, including patient in that decision making. And I think there is now mounting evidence, there’s an increasing evidence on better outcomes in health literate patients. So if patients have a there’s a higher literacy, among certain patient groups, there’s a lot of evidence from HIV oncology, rare cancers, even Hep C, showing that those patients tend to do better yes, there are some caveats, social determinants of health play a role. So patients who are more health literate tend to be more socially, you know, on the on the higher end. But even if you balance those parameters out, it comes out as one of the big factors in terms of outcomes. So I think if you look at all of those factors, I think it’s really important and critical that we, the patient education is front and center. The only thing I’ll add is we must be obviously have to follow respective codes of conduct with an internal policies within our organizations in providing that information to patient and patient groups.

Garth Sundem

Okay, well, so health literacy helps to create health outcomes. Patients used to get this education and still do from their HCPs. So Tim, why is it important for medical affairs to have the capability to provide patient education more directly or do we still go through? HCPs?

Tim Mikhelashvili

Yeah, yeah. Well, again, it’s a pleasure to be here to talk to you about this important topic, a Garth, Riaz. I think a patient education is just at the forefront of what pharma and medical affairs can do in order to change our ultimate value proposition and you know, really the reputation of Pharma. We are ultimately in the business of information and communicating that information in terms of medical affairs. But we also converge with our cross functional partners and commercial in that continuum of health care where we help healthcare professionals identify the right patients, suitable patients, and they ultimately help provide access to those medications. So education alone is now incredibly important, as well as the ultimate access to those medications. And so we can intervene, I think in both of those areas in terms of education. Now, the educational balance or equity equilibrium, if you will, is somewhat shifting. In the pendulum is swinging I think towards more of the edge patients and patients are becoming consumers, I think as Riyaz alluded to, where there’s a recent study 2017 Heather Leo, and plus one that surveyed over 2000 physicians across various different settings, and they asked whether or not they prescribe the medication or treatment that they didn’t feel was necessary. 20 percent of whom actually responded that positively that they that their treatments they admitted, were not necessary. And when asked why most 80% said because of fear of lawsuit litigation, and secondly, a 59%, because patients demanded those treatments, so patients are becoming much more proactive than ever. And we have to learn how physicians educate patients as well in order to model how we can best educate them as well. And so one of the best examples I have of that, that I’ll share very quickly is Dr. Keith Ferdinand, a cardiologist who’s written publications and textbooks, and he’s the author of The JNC seven guidelines. And he actually had a non revenue generating room in his very busy clinic, where patients went, and they listened to videos, to lots of articles that he actually prescribed them to, to. And afterwards, he would actually ask them and re refer to them to apply for him. So I think we need more, more of those types of approaches, I think in the healthcare setting, which is now becoming somewhat of a challenge in terms of how distracted all of our stakeholders are including patients.

Garth Sundem

So patients are driving their own care, and asking for medicines or treatments and becoming more involved in their own treatment journey. And so I guess, if patients are going to be driving their treatment journey, they need to be informed of you know, what the best treatment journey is. So, RIAs, how do we provide this? How does Medical Affairs educate patients?

Riaz Abbas

Yeah, that’s a that’s a great, great question. And a great segue, I would say. And again, I would highlight the fact that it can be sensitive and possibly even controversial topic of some of our organizations, I believe the last I looked at the code of ethics, there is no way to say is that we there is no compliance requirement, basically, in bringing benefits to patients. Okay. So unfortunately, sometimes what happens in my experience, we get too tied up with the compliance framework, what we can can’t do. And if you look at most code of conduct, now, there’s a lot of gray area, and more importantly, they’re moving to words, principle based practices. So I think, by parts, if we keep that front and center that what the information we’re providing is accurate, is going to bring benefit, because let’s be honest, our medicines don’t actually connect to the also cause harm, financial harm, we have adverse events, we have side effects, and we monitor those very, very carefully. Now, how we do it is, in my opinion, partnering with the right stakeholders, so there is an increasing role of what I call a peer educators of patient peers. So these are well informed, highly literate, from a health and clinical data perspective, we can we partner with them in providing that information to Tim’s point, we can also we should also be partnering with ACPs. In my experience, though, the information we provide has to be relevant to that particular stakeholder. So the information sometimes from medical and scientific affairs coming in can be bit too technical jargon heavy. So by partnering with peer educators, as well as HCPs, in my experience, we can actually make it more relevant for the patient groups. So we can partner as developer as best you know, have that information, partner with them and provide that information so that patients can ultimately benefit from the information. Well,

Garth Sundem

so when we’re interfacing with HCPs, I mean, that’s been the traditional role of medical affairs, but our education was aimed is it sort of stopped with the HCP? You know, we’re helping them provide better care. Are we explicit now in some of the education that we’re providing HCPs that that, that it should flow through to patients? Or or are we still just educating HCPs? And they can do whatever they want with it. Tim, what do you think?

Tim Mikhelashvili

Yeah, it’s a little bit of both, I think you raise a very important question. And I’ll continue off of health literacy and a lot of some of the misinformation that may take place that Riaz just mentioned. In order to also, you know, consider how global our medical education is in terms of its impact on any level in any in any country. Right, because of the access to various different channels, social media, but also in terms of a lot of the rare diseases for which now treatments are being being made available to patients. So they may not even know that there is a treatment available for this particular rare disease, much less really baby able to understand or trained to interpret that information correctly, and then in the language that is native to them. So, you know, I remember a patient education materials that our commercial colleagues were developing, right, that we, we were then able to either communicate or, you know, consider, you know, or communicate the need for them. But I think that medical affairs can take more proactive role in both identifying that need, and ultimately serving that need in Malta, in terms of in multiple different languages to make that education available. And, you know, and accessible as well. So I say, you know, in general, we, there are lots of, I think, restrictions that we can convert into opportunities, interpreters, in terms of compliance, and now is the appropriate time to do that. And with in terms of that equal equilibrium of education that’s changing those tasks, you know, of education to HCPs can be also transformed into conversations into building communities, partnering with patient advocate advocacy groups, as medical affairs, departments are now also being restructured, reorganized, also, including patient advocacy groups within medical, and then also convert, you know, really translating the quality of that education into quantity in some different ways of not just expressing the acceptance of education, but also the knowledge acquisition and behavioral outcomes and validating going to layer or layer deeper to validate that, you know, in, in, in medical, for example, you know, payers, a payers are our state important stakeholders that sometimes medical has impact on educating, let’s say, nurse managers or case case managers of different health insurance plans on the adherence of medication, because remember, once once you have that education, a third of the patients do not really adhere to it, even as healthcare professionals. And so I remember being a proxy to patient education in terms of educating payers, on the importance of adherence as a global initiative.

Garth Sundem

So you brought up something I want to dig in on, and you started by saying, misinformation. So and you’re saying that, you know, now is the time that medical affairs really has the opportunity and the responsibility to better educate patients? Riaz is that partly because of the climate of misinformation?

Riaz Abbas

I completely agree with that there is a big misinformation is something that we have to be very, very careful of we have, I think social media has its pros and cons, as we know, and we are living in an age where information sped faster. And there’s, unfortunately, a lot of misinformation. And for that reason, I think we need to behave, we need to partner and ensure that accurate information is also is more predominantly shared. The other thing I’ll add is that I think, when you ask what should we be doing, I believe there are three things we need to do. Number one, I believe that we need to have right external partnerships I was alluding to, so we partner with the right patient groups, the rightly well informed peer navigator than educators. And if there isn’t one, we need to create that. The second thing we need to do is we need to get the right information with those stakeholders develop the right information for patients to your point to to limit the whole situation around misinformation. And third, and probably the most important thing we need to do is to create better internal partnerships with our cross functional partners to make sure because our goal is ultimately the same. We all striving towards better outcomes. So that there isn’t this concern, or am I stepping on people’s toes? Or how is that going to go? So having that internal collaboration is also very pivotal in making sure that we are fulfilling our, I believe ethical responsibility in providing accurate information which leads to benefit to patients.

Garth Sundem

So that’s interesting. I’ve heard a lot about stakeholder expansion, you know, looking beyond just the HCP to you know, or just the person publishing in, you know, biggest on PubMed or presenting the most Basco but I haven’t heard stakeholder creation before. So you’re saying if there isn’t the peer navigator out there, who you can find maybe Medical Affairs and you still work to create some of this education infrastructure out in the world. Tim, what do you think about that? Should Medical Affairs be? I don’t know, what creating their own stakeholders?

Tim Mikhelashvili

Yes, I think and this list of stakeholders is growing, and, you know, during the lifecycle of a product or a pipeline, that strategy in terms of whose perspectives you need to really consider and when also is changing. So I agree in general, that, you know, we have to be consistent, I think, with the ecosystem with our environment, in terms of as medical affairs, leaders, and employees. Because that’s changing, our environment is changing. And, you know, for example, the COVID, right, the pandemic, really is a great example of that, where there was a case of a medical affairs organization that had a product for that was used, that had unapproved uses as well. And that took the lead in direct to consumer education, not promotion, but education in order to, to, you know, share the correct and accurate data that Riaz was mentioning. And so, I think patients, and all of our stakeholders are hungry for more information, as that’s summarized in ways that can be digested. And, you know, we can take the models of various different academic institutions that during the pandemic, you know, some stopped their voluntary endoscopy training programs in GI, for example, others continued virtually, right. Others actually had a catalog central repository in a form of YouTube channel, as well as Twitter, Twitter, or, you know, as well, so they adapted and so we have to follow the same same course of action because I seen examples of Eli Lilly and Pfizer having their own podcast podcast is another way to actually reach and educate patients in a way that they prefer. So, absolutely.

Garth Sundem

So reaching new audiences in new ways. And might you know, one of my takeaways from this podcast is that, again, health literacy equals not equals but at least promotes health outcomes. And we were reaching new people through social media through podcasts through YouTube, but also in a landscape of a lot of challenge. So thank you, Tim. And Riaz for joining us today. To learn more about how medical affairs approaches patient education. Visit the MAPS Content Hub and source for external education. That’s medical affairs.org/content hub. Don’t forget to subscribe, and we hope you enjoyed this episode of the MAPS podcast series. Elevate