Sean Markwardt, Managing Director of Medical Affairs at Avant Healthcare, discusses how Medical Affairs can help bridge the "complexity gap"—the idea that social, technological, and cultural reality evolves at a faster rate than human institutions.
Sean Markwardt: I’ll get to Bowie in a minute, but first I wanted to make the potential ambiguity of our title a bit more clear. It’s probably no surprise to anyone here that the pharma industry is about ten years behind most other industries when it comes to innovation, trends, technology, and even customer centricity. And in my own estimation, it’s quite possible that Medical Affairs organizations could be five to ten years behind their commercial counterparts. And so the argument I’m about to make is that understanding and making incremental changes toward one fundamental concept can accelerate the support and value that Medical Affairs delivers to both its customers and the healthcare community. Before I get to that concept, I want to start with a quick case study from a different market.
When Tesla launched – and I personally had this judgment – people thought they were crazy because they were selling cars out of showrooms in shopping malls. What you’re looking at here is a Tesla pop-up store. Elon Musk is selling cars the same way Kanye sells his Yeezy sneakers outside of concerts for people who couldn’t score tickets to his show. This seemed really crazy at the time, and it may still seem crazy, but Tesla also has one of the largest market capitalizations of any automotive company, and their share price has increased by a multiple of 10 in the last 5 years, compared to General Motors, Toyota, Daimler, and Fiat who have barely held a stable share value in the last 5 years, so clearly they’re doing something right. This illustrates a really important point in Tesla’s behavior, which shows their willingness to adapt to customers in ways their competition does not – and that point is the concept of this presentation – which is called the Complexity Gap.
So, put simply, the Complexity Gap says that social, technological, and cultural reality evolves at a faster rate than human institutions. “Human institutions” means my business, your business, any business. The closer that companies can be to that reality, or the faster that companies can close that gap – is directly correlated to their success.
And this brings us to how David Bowie inspired this talk. Over a 50-year career, he was an example for how changing to reflect the times we live in can produce success. He led the times, he constantly reinvented, and stayed fresh.
Why is this Complexity Gap important to know about? Shoshana Zuboff is a Harvard Professor and author of The Age of Surveillance Capitalism, and to reduce that 500-page tome into a single phrase, she says that every hundred years or so, there’s a fundamental change in consumption that most companies can’t meet the demand of. BUT, the companies who can meet those changes are the ones who are going to be successful. And we’re experiencing one of those fundamental changes right now – an example is how Twitter helped activate millions of people to collapse governments and give rise to the Arab Spring just a handful of years ago. Ironically, the same concept is how Kylie Jenner sold half of her company that sells puffy lips and smokey eyes for 1.2 BILLION dollars – because she was able to communicate and operate in a way that closed the Complexity Gap.
Now back to David Bowie – I’m sure it’s an accident that he maybe gave some of the best advice for anyone who’s trying to communicate anything and stay relevant over a relatively long period of time, which is to turn and face the strange. A lot of things can seem new, different, odd, or uncomfortable, but by embracing that strangeness, and evolving with it, can help us to continue to be successful and even differentiate in a competitive market.
The thesis of the next 15 minutes is that, in our currently changing culture and healthcare environment, Medical Affairs organizations have a duty, or at least an opportunity, to come up with solutions that help close the Complexity Gap between how people are operating and how we are operating. And it’s our belief that, even in the absence of wide scale or revolutionary adaptations by Medical Affairs, there are at least 3 things that can be acutely addressed that can help close the Complexity Gap.
Because whether we like it or not, many things are changing – technology, attitudes, behaviors, and expectations. We could easily spend an hour alone on this slide, but let’s put this to a practical experiment.
The first dimension of the Complexity Gap is how people operate. So even though we’re in the middle of a work day, put your professional life aside for a minute and just browse this list of social platforms.
The other dimension of the Complexity Gap is how businesses operate. Now, we’re only talking about a small part of what is changing, but continuing on the same path of digital communication, consider these professional platforms for HCPs that are analogous to the social platforms that most of you just admitted to using. How many or how often are you using these channels – in your business – as a vehicle for your own data, content, and messages?
What does this mean? Let’s begin to move from the concept of the Complexity Gap, and talk a bit more tangibly about what this means for Medical Affairs and how we can begin to implement it with strategic and tactical plans.
But first I’ll proactively address a really good argument against the one that I’m trying to make: which is that physicians, on average, are getting older and the changes we’re discussing are less relevant compared to our culture in general. And this is true – the average age of physicians right now is about 51, and there’s been a 25% increase in the last decade, of the number of physicians aged 60 and older.
However, almost three-quarters of Americans 50–64 years old are using at least one social media platform. So, it’s not so far-fetched that in addition to liking their friends’ beach pictures or playing Fruit Ninja, HCPs are also using new or unconventional channels to get information that informs how they make decisions or have conversations with their patients.
Personally, I’m ambivalent about the net positive or negative effect of Amazon, but at least one thought that Jeff Bezos has, resonates with me. And that is, he says he’s often asked what’s going to change in the next 10 years and how it could change his business strategy. But he says the more important question, and the one to build a business strategy around, is what is not going to change.
For pharma and healthcare in general, and for Medical Affairs, there’s more than one answer to that question, but the one I’m willing to take a pretty heavy bet on…
…is that healthcare professionals will not be robots. Big data computing and artificial intelligence are important assets, but will not be taking over medical decision making any time soon; sure, you might have involvement from things like telehealth and there’s more digital tools, but they won’t be replacing human decision making. And this is important because it means HCPs – our audience – is subject to the same cognitive biases, preferences, and mental heuristics, that you and I have when something catches our attention scrolling through Instagram.
And if we can assume that’s true, the next important point to make is to consider the transformed relationship between awareness and value. I’m sure that at least a few of you are thinking this is sounds like marketing jargon, so let me give you a practical example. If you were working in breast cancer a decade or two ago, you might partner with patient advocacy organizations to sponsor fundraising walks and talk about breast cancer statistics at congresses or even put up banner ads to a medical website. And you would do all those things and THEN you would say “oh by the way, we happen to have a medicine for breast cancer.” So that’s creating awareness that leads to the value of what you have to offer.
But now, competition for awareness is accelerating, and I’m not just talking about competition with other pharmaceutical companies, but competition with the barking dog or the crying child or the A/C repairman or the newest Netflix series – especially in the context of COVID-19. So what’s needed to compete is creating something of value – to HCPs, to patients, to caregivers, to payers – and that value is rewarded with their awareness of what you want to say.
Here’s an adjacent example of that: if you want to bring value to HCPs, whether on the front line of COVID-19 or the front line of any disease diagnosis and treatment, and you happen to be Banksy, you paint a picture. So this picture of a child holding a nurse with a cape flying over the other superhero icons of Batman and Spiderman – this is really tapping into what the people walking by this, value.
If you’re NOT Banksy, and instead you’re a pharma company, it’s important to understand what your customers and what your audience finds valuable. There’s a lot of noise out there and the first step in beginning to close the Complexity Gap is earning engagement. If we want HCPs, or whoever else, to listen to what we have to say, if we want people in seats at a symposium or standing in front of our posters or picking up the phone when we need something…we have to earn that. We have to earn it by providing them something of value in exchange.
You’re looking at a snapshot of the growth in oncology pipeline therapies, and my next point is that, if you think about it, with the increasing complexity and greater and greater personalization of medicine, and the fact that more therapies are being approved with smaller sets of clinical trial data and based more on real world evidence, Medical Affairs is perhaps the best suited to earn that engagement. It’s getting more difficult to communicate nuances, or have necessary conversations with a sales aid or in a commercial setting. There was a survey done in April asking physicians who they’d be prioritizing contact with in Pharma during COVID and quarantine protocols. Sales Reps had the same preference as “none” at about 25%, but almost 40% of physicians said they’d prioritize contact with Medical Affairs and Medical Science Liaisons.
Back to the original thesis I shared at the beginning – tapping into what and how HCPs get value from pharma is, and increasingly will be, the responsibility of Medical Affairs organizations.
Another thing that Kylie Jenner’s success tells us is that reaching an audience isn’t just about the message or the product – there were plenty of other makeup companies before her – but she tapped into an audience with her social status as an influencer. What this says about Medical Affairs, because I’m not suggesting everyone hops on Twitter to get 10 million followers, but it says that it’s not just the message but also the messenger. And so telling better stories and delivering messages, and value that resonates – it’s on Medical Affairs…it’s on us…to be that messenger. And I think HCPs will crave and demand that more and more.
So if you’re still with me, you may be thinking that this will be hard or even impossible – I get it. Legal, Regulatory approval can be challenging, and anything that looks new and different or dare I even say – creative – can be assumed to be promotional or something that Marketing should be doing. And we could spend the next 3 sessions talking about how to navigate that but it’s already starting to happen – Genentech has a YouTube reality show series about hemophilia. Augmented Reality and Virtual Escape Rooms – as long as the value is clear – these things can happen in the context of Medical Affairs, and they connect with HCPs in a similar way that other, non-pharma companies connect with them as people.
The three areas that can give a better ability to tell compelling and valuable scientific stories, that don’t need radical change, and don’t need to be preceded by an organizational revolution, are design, digital, and personal, or personalization. Starting with design, there have literally been hundreds of scientific studies done – fMRI, optical tracking, working memory experiments – that all objectively say…
…that this…is simply a terrible piece of content to put in front of any human being if you expect them to understand, let alone recall or apply, the information you’re trying to communicate. But how many of you have seen or even used slides that look like this?
I attended the Medical Affairs Professional Society meeting in Miami back in March, and across many sessions and audience comments, it felt like a running joke that Medical Affairs was forever destined to have ugly slides that can make anyone’s head spin, because anything that is simple, or eye-catching, or may appeal to a single neuron of the human subconscious – well then it doesn’t “feel scientific”.
It doesn’t have to be this way. We’ve seen it work many times and admittedly it’s not always been easy, but going the extra mile is also what allows people and organizations not just to deliver value, but deliver differentiated value.
The second thing is digital. And this is only one piece of what digital looks like, but I’ll focus on what I’ll refer to as professional social media. The big prediction is that HCPs will not be robots, and so they’re susceptible to acting like regular people. We also know that they prefer learning from each other and so these platforms are at the intersection of those two things, and they have tens of thousands of HCPs actively engaging with them. They’re engaging while preparing for their day, at the point of care, or scrolling through case studies while Real Housewives is on in the background. But as far as I know, there hasn’t been a mad rush of Medical Affairs lining up to distribute their message on these platforms, and so they represent an opportunity to start closing the Complexity Gap.
And the third dimension is personalization. These companies – Netflix, Amazon, Spotify – close the Complexity Gap, or I suppose one could argue that they may have contributed to the Complexity Gap, but the point is that they provide value to customers by putting content and products at their fingertips, and in ways that are highly specific to the individual who’s using it.
When I was in the 7th grade and the Smashing Pumpkins released Mellon Collie and the Infinite Sadness, I had to ask my mom to drive me to the mall, I walked a quarter mile to the escalator, turned the corner at the top and into the Sam Goody another 300 feet away, and after I found the CD and stood in line for 10 minutes, only to have to wait even longer until I got home and tore off the plastic packaging to put in the stereo that was plugged into the wall before I heard Billy Corgan’s first piano note. 7th graders today? They can get almost any song they want in about 5 clicks without having to move. AND they get custom recommendations to listen to similar artists they may not have even heard of yet.
Now, I’m not recommending that you go digitize everything and build algorithms for content recommendations. What I am suggesting is that training on or just emphasizing the opportunity that exists for MSLs to understand more deeply and authentically the needs of their HCPs, beyond data alone – that can go a long way.
These ideas and concepts may not be what typically occupy your work days, or they may seem far away, or too challenging to take on, or other things are keeping us too busy. In which case I’ll end by echoing David Bowie to say, tomorrow belongs to those who can hear it coming.
So again, thanks for hanging out with us, and I appreciate your time.