Garth Sundem   00:00

Welcome to this episode of the Medical Affairs Professional Society podcast series: “Elevate”. I’m your host, Garth Sundem, Communications Director of MAPS. And today as we enter the holiday season, we are exploring the ghosts of MSL past, present and future. Joining us are David Williams, Chief Medical Officer at VISFO, Carol Heggie, Vice President of Field Medical at Takeda, and Ryan McClellan, Senior Director of Medical Excellence also at Takeda. This podcast is made possible by VISFO, reimagining the delivery of science. So, David, you and I spoke previously for an article about Medical Affairs mind reading. And so, I know you’ve been around the business long enough to have been personally acquainted with MSL past, we’ll call you the Mr. Fezziwig of this discussion. So, why don’t you start us out with the tale of our first visitation by the ghost of MSL past?

David Williams   01:05

Yeah, it’s, it’s an interesting history, I think it’s a reflection of where the industry has come from in terms of this perspective of, you know, maybe a sales focused type role, where you get a group of people together, seeing as many external customers as possible, right, you’re trying to generate noise and, and discussion around in the broadcast type of way. So, I’m telling you, what the sorts of things the attitude of the business is, to a certain drug and disease area, I’ve always, it’s always irritated me a bit in terms of understanding that, in the end, what we’re doing is bringing medicines to people, you know, patients are the ones who are getting this. And science, you know, moving at the speed of science, mostly, is a relatively short, slow thing. So, you have to invest the company to have to invest long term into the relationships of science. So, MSLs was brought into the picture late, six months before launch, you know, people hire, train, blah, blah, blah, it takes a lot longer than six months to get things moving. And it’s almost like a slightly after thought that the MSLs were brought in, because the scientific environment was not seen as something that we could change the influence. And I think that’s where the past was focused. And I think that’s where the challenge of the industry probably didn’t see a potential broader role. And obviously, that my fellow guests who will have that discussion, some of the best in the business MSL activities, so having that that view, but I think it’s trying to drag yourself from that kind of view, and it’s not easy to do, you know, and

Garth Sundem   03:00

Well, Carol, you know, so bringing in MSLs late and mostly with a sales role, maybe if you could introduce your experience just a little bit and then talk about how the MSL was seen by the organization.

Carol Heggie   03:18

So, I agree with him, and I think the roles involved to something that was a pipe dream. You know, when I think back to the beginning my career in the MSL world 10 years ago, I never believed that we could bring the value to the organization. Well, I did believe but it was a long journey away, to realize that I think the MSL role was always seen as a transactional role. We take science to the HCP. We give them the information, we present our data to them, healthcare data, disease state data to the customer. Whether that was a KOL, or someone in the KOL’s environment, we transactionally gifted them with this information. I think where we are now and what it is evolving to even more is an interactive presentation, is an interactive environment. And it’s a two-way exchange of information. You know, I tell those who work with me and Ryan will have heard me say this on many occasions, our role, yes, is to disseminate science, but it’s to disseminate our science with a view to understanding the relevance of that science, the applicability of that science, and what in essence, that science does to benefit patient outcomes. And we can only do that by asking the right questions of our customers and listening with the right ear for the answers, and then bringing that information back to the company to allow them to improve the offerings that we make and to hone our scientific strategy

Garth Sundem   05:00

So, in addition to being late and somewhat sales focused, the ghost of MSL past was also a one-way street of information. Yeah. Ryan, what else? What else did you used to see in this past role of the MSL?

Ryan McClellan   05:17

Yeah, no, I think I agree with both Carol and David. And in that transactional type of relationship, it really was one way and you were providing information, and you didn’t necessarily always get information back. And so, you never really knew, you know, where sometimes that information sat with the HCP or with the KOL. And that some may give you feedback, some may have just sat there kind of listened to you. And you’re always kind of wondered what happened, you know, and or why were you even there, you know, and that made that that interaction a lot more difficult. And I think that’s one of the things that was really hard. When I first started as an MSL 15 years ago, was that sometimes you’d go in and you just didn’t understand if the HCP really wanted you there was really getting any benefit from the interaction, was there really value being developed there, and you always wanted to try to bring that value. But you always had that hard with that one-way street type of mentality, it was really hard to really judge whether that value was there. And so, maybe the only time you got to learn whether there was a valuable interaction there was they let you come back the next time. Otherwise, it may not have been, you know, is the last cost.

Carol Heggie   06:38

I think that also presented a big issue in terms of how the MSL role was perceived by companies, because it was transactional in the same way as a sales role was transactional. We were looked at often, and being judged by the same yardstick in a way that they couldn’t understand why we couldn’t meet the same metrics as sales teams could. So, we’re a sales rep may be asked to rush out, run around, see 20 customers a week. You know, whatever that that environment was, as an MSL, you were being asked to be thoughtful and methodical and well-prepared for your interactions, and then to spend a longer, easier amount of time with the customer fully elaborating on that science and it wasn’t a glossy brochure paint detail. And I’m not demeaning that glossy brochure detail that, but it’s a different interaction with the customer, which takes longer and takes longer to prepare for but when it’s a transactional thing, being viewed by our commercial colleagues as a transactional interaction, it’s a well, why aren’t you able to do 20 also? So, I think it you know, you can see where there was a complete lack of understanding of the differences between the role when it was this one way communication.

Garth Sundem   08:01

All right, David, bring us into the present. Well, first of all, that was a horrifying ghost of MSL past. So, maybe, maybe the MSL present, it seems like the horrifying thing that I hear so much about is the pace of change. But where are we at right now? David, where are we at with MSL present?

David Williams   08:20

I think I think there’s a there’s a tipping point change. Okay, I think the pandemic has caused a real acceleration of digital technology thinking, and it’s about this remote interaction activity, how do you engage across the screen, how do you engage across the country, how do you engage across the world, you know, because it’s, it’s shrunk up faster, and everything’s got changing really quickly. And that, you know, that the pace of movement is painful, you know, and I think that transition from the past to the to the present, has been a very difficult situation for a lot of people because they have to learn new skills, companies have to learn new ways. And I think what is happening in the present, varies by company. What we see as a health tech consultancy is a breadth of companies doing different things in different ways. They’ve all got the same challenges, but they all do it in a different way. And I think that’s, they evolve different processes. One of the things that Takeda are great had, they’re actually a lot more nimble than a lot of organizations that we’ve come across. But the business processes haven’t kept up with the rate of change that the businesses are expecting. So, data privacy, processes changes. There’s a whole list of them, right. So, what is having to happen what we’re seeing is this, this oil tanker changing, to having to in this new space, while the whole world is changing, so that’s the present thing. I think the most Important lesson is how do we deal with the projection into the digital world of this knowledge-based dialogue? And really, that is the thing that we’re seeing a lot of is the scramble. It’s almost literally a scramble for how do we do it? How are we effectively doing it? And as Ryan said earlier on, Carol said, how do you measure it? You know, if you’re not looking at coverage and frequency, which is what Carol was talking about, I’ve seen lots of people I’ve seen a lot of times, but how do you say, I’ve seen one person in the last two weeks, but it was the most important person in the planet in that disease area, we had an hour’s conversation, that person now believes something completely different from what they have done, because I’ve discussed my data with them in a knowledge based way. And then that, then is the most valuable thing you do all year. And it’s that transition thinking because of the pandemic is brought it all together from five years-worth of change into a year. We’re having those conversations. So, it’s like popping candy all over the place.

Garth Sundem   11:07

So, everybody’s got the same challenges. And there are many different solutions in the present, one of which is his measurements. Ryan, what are you seeing in the present?

Ryan McClellan   11:20

Yeah, I think one of the other pieces that we’re starting to see in the present is, is the change in the expectation of the MSL, in that transaction moving from that transactional type of relationship where we just provide information to looking at how can we better provide service to our customer, you know, to the HCP, to the KOL? You know, what are their needs? What are they needing from us, you know, whether that be additional data, whether that be, you know, involvement in studies, or whatever the tool is that they’re looking for? How can we provide more of a service-type level to them, rather than just going in and exchanging some information and leaving? And so, I think that’s also resulting in the need for a different skill set sometimes with within the MSL role, and how do we, and how do MSLs upskill to meet that need, because there’s just a different expectation from KOLs than you know, there may have been in the past.

Garth Sundem   12:19

Alright, so, I feel like in the Dickens’s take on things, the ghost of the future was terrifying. And was not such a pleasant vision for Ebenezer Scrooge. But I feel like we may be taking the opposite approach. Let’s look into the, into the future of the MSL. What is the future of the MSL? And Carol, David, whoever wants to start out go for it?

Carol Heggie   12:49

Yeah, I think the future is actually really exciting because I think that companies are starting to recognize the value that the MSL relationship brings. You know, we always looked at that face-to-face interaction, in different medium as having different values. So, the one-to-one interaction was valued from a certain perspective, the ad board environment, for instance, there’s no company out there that doesn’t have a medical or scientific advisory board was seen as sometimes being more valuable to the strategic objectives. And I think that that thinking is changed. Because what we’re seeing now is, as our own MSLs become more polished at asking insightful questions, at engaging an appreciative inquiry, when they’re with their customers, the level of insight that we are able to glean from customers is at a level above and beyond what can often be achieved in advisory boards, and has become a huge currency for the MSL team internally, with the teams. And that’s why, you know, I think that we are relying on technology a great deal. But to Ryan’s point, we also have to look at how do we upskill ourselves, the biggest barrier that we have to this wonderful future that I see, is getting out of our own heads, and thinking of these interactions, as being something we have to do face to face, and becoming more polished at communicating via a medium like this, where we may be behind a screen, we may be on a phone, but we can still connect to the person on the other side very, very effectively.

Garth Sundem   14:32

And strategically. That’s one thing I heard you say. Go ahead, David.

David Williams   14:36

I think the face of Pharma is going to change. And it is the different view of the Dickensian story is that the you’re training people and you hire smart people, right? And you want them to be smart and trained up to be smart in their interactions, rather than telling them what to do. You almost train him to be like Special Forces rather than infantry, because they have to make decisions there and then they, they see people for 45 minutes, if you’re seeing the top person in the world for 45 minutes for interactive discussion, you better be evidence loaded, to have that conversation, you have to have their publications, their networks, their digital opinion, in the back of your head, you need to be sharp, because they, as Ryan said, they’re gonna judge you. And if you if you’re not good enough, you’re not coming back. And I think it’s having that projection. The outside world is really important. Also, I think, for the reputation of the company, because you get, they judge you on the interaction they have next time. So, if your interaction is a fully-loaded, evidence-equipped, professional, polished MSL, to your company, that’s a competitive advantage for your organization, as opposed to the opposite, where a company doesn’t have that. So, the face of pharma in the field is very medical, because it has to be at the end of the day, people are prescribing drugs to patients, it’s a serious business. You know, Carol, you know, we’ve all got healthcare backgrounds on this call if I was a pharmacist, nurse, and I’m a clinical person medical. So, we all know the importance of that decision. So, the better decisions or conversations the MSLs can have better decisions that information, the KOLs have. And that’s the important thing. I don’t know what Ryan you feel at all.

Ryan McClellan   16:36

And I think another piece to that is, is that, uh, that digital piece or that virtual piece, because now information is there’s an expectation of, you know, getting the information instantly, right. And, you know, the idea of having to wait two weeks to set up a call and get a meeting and travel and do all those pieces to get that information that the HCP’s wanting is it’s waiting. I mean, that is that is the past, right? They want to be able to I mean, I think there’s an expectation for some that they want to be able to jump on a call when they have a question almost instantaneously or within, you know, a few hours to get an answer to that question. And so, how is it you know, as we go forward to make sure we can meet that need as an MSL team, because you’re not going to have that time to spend, you know, two weeks to set up those meetings and then get out there and see them? That question may be irrelevant at that point. So, you know, making sure we’re able to upskill our teams in digital tool use and having all that knowledge at our fingertips to be able to answer those questions quickly is very important as we go forward.

Garth Sundem   17:37

Knowledge at our fingertips, is that the is that the driving force? Well, you know, another thing that strikes me is that we were talking about in the in the past, there was a very transactional and sales focused role for the MSL and it was almost as if the goal was the sale still from medical. And now I hear everyone on this call saying that the goal is better prescribing. Are we moving towards a more patient-centric perspective for the MSL?

Carol Heggie   18:04

100%? I think actually Medical Affairs has been patient-centric for a long time. I think pharma in general is trying to move towards that. But medical was always very focused on the patient outcome. I think now, we’re able to verbalize and, and visualize those outcomes in a much better way. I think that through the expansion of each your health related health economics and outcomes research, we’re actually able to show some of the data that we’ve collected and analyzed as having better effects on patients. I think where the MSL fits into that paradigm, however, is that where the MSL is able to take such data and understand how that data connects to the customer in advance. So, I’m a great believer in don’t waste my time, if we can go to a customer understanding who their patient is, how they’re treating their patient currently, what their goals are in terms of patient outcomes, and take with that to them and discuss with them evidence that will help to enhance their patient outcomes. It not only makes us patient-centric, it makes us valuable to that customer in improving their patient outcomes. And I think that’s one of the core drivers. So, it’s information at our fingertips, but it’s to allow us to prepare and execute in a way that fits the customer individually, and to tailor our interaction to what the customer needs to achieve their patient goals.

Garth Sundem   19:37

Well, and Ryan, you mentioned that the only way to measure the impact of your activities was whether or not you got to come back again. But now in this new informational data landscape, are there new ways to measure the success of MSLs? Is that part of the MSL future?

Ryan McClellan   19:56

Yeah, no, I definitely agree that that is part of the future. I mean, there are many different ways. I mean, there’s the traditional metric way, you know, just number of visits. But I think we need to go beyond that, right? We need to look at what is what is the quality of the insights or the information that the MSL is able to engage with HCP and bring back to the company, you know, it, we go in, you know, with our certain medical strategies or medical goals on that we want to talk about, right. But we need to also be receptive and listen to what the HCP wants to talk about, and what what’s interesting to them, and make sure we’re supplying them with that information. And having that capability to capture that and see where those trends are. See where those topics are, what are the patient’s interests, what are the things that they’re hearing from their patients, is very important to show our value, because we can bring that back to the company. And we can say, you know, these are the things that we’re hearing from our customers and in the field, and how can we adjust our strategies, adjust the data that we’re sharing, adjust the information that we can make available to them to meet those needs? And I think that is a, you know, that’s the ultimate Holy Grail. I don’t think, you know, we’ve fully solved that piece. But, you know, I think we’re making strides in the ability with all the different data technologies that are out there now is making that possible. And it’s, it’s just, you know, trying to find a way to do that most effectively for your organization.

Garth Sundem   21:17

David, last thoughts on the ghosts of MSL future?

David Williams   21:22

Yeah, I think I think the enablement using the tailored digital solutions is what we’re trying to build with Carol and Ryan at the moment, we initially went into conversations thinking, we will provide information but in the end, what we’re doing is strides towards change management, using opinionated software, using digital analytics, machine learning, AI. And it’s interesting that what we’ve done is shorten the distance between the insight the head office, the head, office and insight. And what you’re doing, therefore is making real time smart decisions easier. The team’s work more efficiently. You’re sparing people, huge amount of time. And it’s been an interesting trip for VISFO as it has been for Takeda is that in reality, we’ve, we’ve changed, it’s a change management process there. And this whole new series of things coming out of the woodwork that we need to change to work with the teams, spent hours talking to the MSLs about what they want, and how they want to do it. And then it gives you the credit to say actually, we can go back to them and say, you’ve told us this, we’ve done that, and Ryan and Carol have been brilliant. And working, you know Ryan speaks, you know, weekly with our IT guys to finesse things because in the end, it’s not being given digital stuff. It’s about having things that work for you and with you. That’s the key critical strategic need. And that’s the thing.

Garth Sundem   22:58

It’s not just here is the future of the MSL role and we built this thing for you and it’s a technology and go use it. It’s bringing people along from MSL present to MSL future. Now that’s, I wish we had another hour. All right. Let’s leave it here for today. I thank you, David, Carol and Ryan for joining us today. To learn more about how VISFO can help you harness the power of cutting-edge data streams, check out VISFOrmatics.net Don’t forget to subscribe, and we hope you’ve enjoyed this episode of the Medical Affairs Professional Society podcast series: “Elevate”.