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The mission of Medical Affairs is to ensure patients receive maximum benefit from biopharma and MedTech innovations. In many cases, working with traditionally underserved populations offers the opportunity to do the most good. Here MAPS speaks with Anatoly Geyfman, VP of Medical Devices at H1, about what Medical Affairs can do to promote health equity and address social determinants of health.
MAPS: You come from the medical device side of the industry – do you see the same challenges of health equity in MedTech as your colleagues’ experience in pharma?
Anatoly: We do see some of the same challenges, for example access in helping to engage physicians and other healthcare professionals around specific diseases and patient populations, especially when it comes to underrepresented or underserved populations – and challenges in access to facilities, as well. Then, with Medical Affairs in the device space, the relationship between upstream physicians and downstream use is even more nuanced than it is in pharma. In pharma you can have a pretty direct relationship between HCP education and making sure patients are prescribed an appropriate treatment. But in MedTech, there can be a lot more steps between HCP education and ensuring patients have access to the right devices and diagnostics, especially in traditionally underserved populations.
MAPS: As Medical Affairs professionals, how can we increase health equity – in MedTech and in pharma as well?
Anatoly: Actually, I just got off a call with three colleagues in the device space – one working in devices for the treatment of structural heart disease, another supporting a cardiovascular defibrillator, and another with a glucose monitoring solution. All three were talking about equity components to their trials in not representing some patient populations well. So, one solution to support health equity is to design trials for inclusion.
MAPS: Right, because if a trial doesn’t include diversity, it’s much more challenging to help a diverse patient population take advantage of a new technology after approval…
Anatoly: Exactly, and it’s not just patient diversity, but clinician and investigator diversity as well. So many trials are at academic medical centers, and they may not be the first place underrepresented groups go for care. These centers themselves haven’t traditionally been diverse.
MAPS: Is one part of the solution, then, for academic medical centers to hire more diverse clinicians and researchers?
Anatoly: Yes, and we’re seeing new models of distributed, decentralized clinical trials where the trial might be run by an academic medical center but is also offered at community health centers. There’s a real opportunity right now with these decentralized trials. We’re seeing more partnerships between academia and community. For example, take the TeleStroke trial, which was run by the Mayo Clinic but was offered in community. Remote second opinion is another example of taking academic-style care into the community. The ability of patients who wouldn’t traditionally have access to academic medical centers engaging remotely or engaging through their community health centers has a huge potential to improve social determinants of health and health outcomes in those communities.
MAPS: You brought up remote engagement – that’s a new trend as well, right?
Anatoly: The pandemic accelerated digital transformation by a decade because there were no other options. Even if we didn’t want to do decentralized trials or distributed teams, we had to learn. Some things will not live past the pandemic, but some things are here to stay – for example, once you serve patients with a decentralized trial, you can’t put that genie back, especially as we start to see the efficacy of these trials. We’ve certainly seen work-life changes due to the pandemic as well. Take travel. There’s been a significant drop in travel and people are increasingly expecting to be able to get care close to where they live – that’s been driving the use of community health centers.
MAPS: So, what can Medical Affairs do even better to ensure health equity?
Anatoly: From within, Medical Affairs can do more to recruit diverse employees in their own ranks – folks that have lived or still live in traditionally underrepresented communities and are familiar with the cultural barriers and the unique needs of patients. Then, we can also create more education opportunities for physicians in community health settings around specific needs for the most affected populations. During COVID, some unorthodox education settings proved to be very effective. And we can ask whether we are engaging patients and physicians in the ways they want to receive education – does it resonate with physicians who will be treating these patients?
MAPS: Earlier, you also mentioned access…
Anatoly: Access is a huge barrier to ensuring patient benefit, either due to challenges with insurance coverage of emerging treatments or due to the care stream. A recent study of heart valve replacement showed that only 32% of cardiologists knew the newest indication. Medical Affairs could educate the other 68%. If patients are seeing physicians who aren’t up on current guidelines, patients may not end up getting lifesaving or life changing treatments. Patients flow through the system in predictable and sometimes unpredictable ways: what are the points in diagnosis or care planning or treatment or adherence where patients are getting off track? Medical Affairs must understand these streams of patient care and patient journeys.
MAPS: It sounds like there’s still a lot to do.
Anatoly: In the U.S. and many other countries, healthcare is the most instrumental industry in the world. There’s so much data about what happens to a patient everywhere they get treated. And we’re just at the beginning of being able to aggregate that data and see patterns, then distill insights about patterns of care and create actions to improve that care. We’re still in the nascent stages of our evolution in this space. Imagine what it looked like when folks were building computers in the Bay Area in the 1960s. Steve Wozniak had to solder chips onto a board for the first computer he built. Look where we are today; we have these beautiful machines. I’m not a techno-utopian, but I’m at least a techno-optimist. Give us time and space to innovate in this space, and we will be able to affect patient outcomes across all communities in a very positive way.