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Connecting the Dots, Episode 1

Podcast Transcript

Sean Armie: Welcome to Connecting the Dots with Avant Healthcare. I'm your host Sean Armie. Today I'm so pleased to have as our very first guest for our very first podcast, Arun Divakaruni. He is our Chief Science Officer. Arun, how are you today?

Arun Divakaruni: I'm doing good. Thank you for having me on, particularly for the inaugural one.

Sean Armie: Yeah. You're the perfect guest. I don't know of any other guest that would wear a Mastodon tee shirt.

Arun Divakaruni: I love Mastodon. I'm a big metal fan. Metal is life for me.

Sean Armie: Metal is life for you. What's your favorite album? Is it Leviathan? Tell me it's Leviathan.

Arun Divakaruni: No, actually Leviathan is good. But I've sort of mellowed in my old age.

Sean Armie: That makes sense.

Arun Divakaruni: So I kind of like the newer stuff a little bit.

Sean Armie: Okay, a little roots-ier.

Arun Divakaruni: Yeah, a little roots-ier here. Like a little bit more jazz in it. You know, They're a complicated band, but my favorites are Metallica and stuff. I'm still trying to be young and listen to what the kids are listening to.

Sean Armie: Okay, cool.

Arun Divakaruni: We could talk about metal all day long. I know that's not why we're here.

Sean Armie: It's not why we're here. It's not why we're here. All right. Arun, tell our audience a little bit about yourself. Where'd you come from before you came to Avant, and what are you doing now?

Arun Divakaruni: That's a very existential question. Where I came from. I think we're all trying to figure that out. At some point I was born, and then I got into science because I come from a family of scientists. They're all engineers and they're really good ones or doctors. So I became a biologist. I was really interested in biology. I went to UCLA and I stayed there for my PhD. During that, I really liked doing science and science was a lot of fun and I was pretty good at it. I've got some good papers and stuff and I studied new targets for antibiotics for super bugs and things like that.

But the lab is actually kind of a lonely place and I like people. Just by kind of happenstance, which happens to a lot of us in our careers, there was an opportunity to do some consulting work with Bain & Company. They were looking for low level of graduate students to do some grunt work and stuff. What I realized is I really liked the intersection of science and business. After graduate school, I ended up at a company called Weber Shandwick, which is an integrated marketing agency. It was sort of a traditional public relations agency and sort of evolved with how marketing has evolved over the last 10 years. I ended up running a good chunk of their scientific communications for their clients, both in the US and globally.

After that, I kind of wanted to expand my skill set. Avant is a great place. This was the next step in my career. So now I'm here. I've been here for about nine months now, I think.

Sean Armie: Awesome. We're obviously so glad to have you here. I know you did mention that you really liked the intersection of the medicine and the business. But I guess would you mind expanding on that? What exactly draws you to, to medical communications over going the research route?

Arun Divakaruni: That's interesting. I mean, the lab is fun and I like doing the science part of it, but if you think about some of the best scientists in history, Galileo had to convince the church that the earth wasn't the center of the universe. Nobody really, at least unless you're a theoretical physicist, really understands what Einstein was talking about. But yet he became one of the most prominent figures in the 20th century. Folks like Darwin had to convince the entire world that evolution was a real thing. To me, not only is the science is important, but it's to get people to understand the science because that's when it actually has some utility for humanity.

In high school, I always wanted to be a lawyer and I don't know why. That's kind of like a weird thing to be particularly when you're that age. But I did like debate. I actually lettered in debate. I wish I lettered in football, but I have the size now but not then. I did the whole debate thing, and that's kind of what, at least, PR was back in the day. So it was more having a conversation with someone and convincing them that this is a real thing. Today with vaccine hesitation and all of these sort of myths that are going around, convincing someone of important science is incredibly important.

Sean Armie: That's so true. I think, yeah like you just said, that the best scientists have also been great PR people.

Arun Divakaruni: Or communicators?

Sean Armie: They're great communicators.

Arun Divakaruni: There's some really interesting data that's come out. Hopefully this will change, but in order for a new medicine to become standard of care, it takes years and years and years. When we think of ourselves as medical marketers, marketing is one way to think about it, another way to think about it is accelerating the distribution of good science and medicine to the people who need it. Let's say if you have a brand new drug, and we live in a very exciting time in science right now, particularly in oncology and in cancer. We are seeing things today that we never thought were possible, like activating the immune system to recognize and destroy cancer, have long durable responses.

It's important that doctors understand that, understand the potential where it should be used, where it shouldn't be used. Marketing and communications plays a critical role in that. Just building the drug itself isn't enough. Being able to build belief that this should be used, where it should be used appropriately is just as important because medicines don't help people who don't get them.

Sean Armie: It's true. It's true. It is not true that if you build it, they will always come.

Arun Divakaruni: No, in fact the opposite, right? If you build it, you have to convince them to come.

Sean Armie: Yeah. All right, let's cut to the chase. What do people get right and what do they get wrong when it comes to scientific communications?

Arun Divakaruni: That's a good question. To me it's all about a story. I think when they get it wrong is when they don't tell a good story to the audience that they need to. The first thing that I think is really important is empathy. Empathy with your audience, where they're coming from. If they're naturally interested in science to begin with, they're probably pretty smart. But you don't have to have a postgraduate degree to be smart. You don't have to even have a lot of familiarity with science to begin with to be smart. To me it's all about telling a compelling story in the language that is authentic to them. So to doctors. We should talk to them as doctors. There's a certain language there. As maybe for other audiences, we can maybe take down the language a little bit and get rid of the jargon. Being complicated for complicated-ness sake is I think what most people get wrong. They also forget that there are simple tools to make complicated things understandable.

For example, you're wearing a Star Wars t-shirt. Which one's your favorite movie? Which one do you like?

Sean Armie: I'd have to say the best one is the Empire Strikes Back.

Arun Divakaruni: It is.

Sean Armie: My family favorite is Return of the Jedi. My kids love it. They love the Ewoks.

Arun Divakaruni: Okay. Perfect. That's perfect. What's kind of the main plot in Return of the Jedi? We got the Battle for Endor.

Sean Armie: Right.

Arun Divakaruni: Right, okay. The Battle for Endor is actually a perfect analogy for how cancer immunotherapy works.

Sean Armie: Okay.

Arun Divakaruni: These checkpoint inhibitors. So you've got this Death Star, and that's our cancer. But it's got the shield around it and the shield prevents it from being attacked by the immune system. It's kind of cloaked. Our immune system are like the TIE fighters and the whole Rebel army. So then what happens? They launch this mission on Endor to uncover or to take out that key station that's providing the energy for that cloak for the Death Star. That's how checkpoint inhibitors work.

Sean Armie: Okay.

Arun Divakaruni: What we're doing with these new drugs, these PD-1s, PD-L1s, CTLA-4s, what they do is they block a key component that prevents the immune system from recognizing and destroying cancer. I could explain something that's very complicated on the bleeding edge of science to not only somebody who maybe doesn't understand science all that well, but guess what? Doctors love Star Wars. So it's important to also think of our audiences as not just what they do by their profession, but who they are as human beings. A little creativity doesn't hurt. That's sort of my take on it because it doesn't have to be boring. It's actually super exciting.

Arun Divakaruni: That's kind of what got me interested in the biology in the first place is that when you look inside our cells, we're made up of trillions of these cells and in my hand and your hand right now, there are just these... It's almost magical what's actually happening. All of these little machines are working together. We're replicating DNA to high fidelity. It's remarkable the beauty and the magic of biology and it's important as communicators for us to make that accessible to people. Then as makers of medicines, how do you explain what your medicine can do both on the molecular terms as one, but what impact does that have for a human being?

Sean Armie: Yeah. Just to follow that up, I know we've talked about making the language accessible and speaking to your audience on their level. But isn't it true that to a certain extent, we have to reach doctors beyond just throwing data at them? We have to communicate to them in a way that we show them perhaps they're overlooking something or perhaps they're not diagnosing the patient in the right way and that's something that a good medical story can take care of.

Arun Divakaruni: Yeah, and that's the point with storytelling. Numbers don't convince people always. Data and charts and graphs and all of those things are important, but it's important within a context and that context becomes that patient. Typically when we're talking about communications around medicines, within the life of a patient that they're trying to treat, within the context of the doctor of his practice or her practice. We have to capture their attention just like we would for another human being and tell a really good compelling story.

Oftentimes I think there's an assumption that doctors know everything about everything when it comes to medicine. Nobody knows everything when it comes to everything about any particular subject. They have the same limitations that we do because they're human beings. It's important that we speak to them in a way that tells a story, teaches them something new, brings them something of value and hopefully can help them understand something new and different about maybe their practice where a new drug may have a role for what type of patient. Because ultimately the end is the same for both the marketer or the communicator and the doctors to improve the life of the patient.

Sean Armie: Okay. Well, I'm glad that you brought up not every doctor knows everything there is to know about medicine because it seems like rare diseases and specialty medicines are the direction that pharma is going right now. It seems like medicines are getting more and more niche. How does this affect our clients, and what does it mean for us in healthcare marketing?

Arun Divakaruni: It means that we have to become better and better. That's a very vague answer, so I'll expand on that a little bit. In my opinion, healthcare is driven in this country and actually around the world by the search for value. Value can mean two different things. It can mean that we can deliver better medicines cheaper, or we can do something that we've never done before. That's why we see our market bifurcating. You have companies that are going after biosimilars and generics and then you have companies who are really pushing the envelope on innovation. What that means then is that how can we improve upon the drugs we have today? Oftentimes that means by matching the right drug to the right patient.

Let's say, for example, cancer is probably the best example of this. Through all the efforts of genome sequencing, we're able to find the genetic drivers of disease and match them to a particular medicine. The first example of this in cancer was a drug called Herceptin. What Herceptin targets is a protein on the surface of breast cancer cells called HER-2. That's found in about 25% of women diagnosed with breast cancer. What you've done is been able to take a disease that's maybe a monolith like breast cancer, find a molecular sort of subtype and create a medicine for that. Now that's happened in breast cancer several times over since then. Now we have drugs that target PI3 kinase. We have medicines that target other sort of genetic drivers including some things that are involved in cancer immunotherapy.

The more we understand about a disease, we recognize that it's not necessarily just one disease but a collection of smaller related diseases. Cancer isn't one disease, it's a family of maybe thousands of related diseases. Likewise, maybe neurological disease like Alzheimer's, for example, is not just one type of Alzheimer's. Maybe there's several different related neurological diseases that we have to take the science and understand what drives them. As they become more niche and niche and niche, it's important for doctors on the front line to understand the science behind it and sort of work that in with their busy schedule of treating patients.

For the oncologist today as an example, not only do they have to treat their patients, they have to manage all the billings and the stuff that happens around medical practice. They're running a clinic, and they have to become a molecular biologist because that's where we're at least oncology is going. How can we expect any one person to do all of those things? It's very difficult, and innovation and all of these new medicines are great, but it's creating tremendous strain on the people who are actually administrating care.

So it's our job as marketers to be able to explain that to them, why they should care with all the other things that are happening and create value for them so they can help incorporate these new medicines into their practice.

Sean Armie: Well it's great that you bring up value because one thing I want to talk about is value based care.

Arun Divakaruni: Those are the three words.

Sean Armie: The new buzzword.

Arun Divakaruni: Yeah.

Sean Armie: The new buzzword, I guess buzz phrase. How are our customers delivering it, and what role do we play?

Arun Divakaruni: It depends on who you are. So if you're a hospital system, delivering value based care means getting the best outcome you can for the least amount of resources. That means making sure that you keep your infection rates low and you're not readmitting people into the hospital after procedure, those types of things.

Arun Divakaruni: For pharmaceutical companies and biotech companies, and particularly the ones that we work with and the ones who have a need for scientific and medical communications, it means that they have to work even that much harder to deliver a new medicine. The low hanging fruit has been picked in medicine. If you think about it, we do a really good job with cardiovascular disease. Statins and blood pressure medicines have been around for a long time and they've made tremendous strides in reducing cardiovascular mortality. What comes after cancer, or what comes after heart disease?

Well, if people aren't dying of heart attacks when they're in their fourth and fifth decade of life, they're developing cancer in maybe their sixth and seventh decade of life. If we can figure that out, then they're developing neurological disease in their eighth or ninth decade of life. The science becomes that much harder. It becomes that much more complicated. It's the power of the human mind to be able to figure out these answers to this.

So there's a lot of interesting modalities that we have now. We have gene therapies that are approved. I mean if you really think about it, you're changing somebody's DNA and fixing an overall defect. There's companies right now that are looking to use RNA or the information molecule of our cell to be able to give that the properties of medicine so you can have the body make its own biologics for example. To me at least, and I think the companies that we like working with and the ones that best match with our skill set as a firm are the ones who are delivering and developing very innovative science that sort of is stuff that you would see in Star Trek or something. How do we take that and make it accessible and understandable to the people who are going to be using it?

Sean Armie: Great. Thank you.

Arun Divakaruni: Well, thank you.

Sean Armie: I'd like to move on to technology.

Arun Divakaruni: That's another big buzz word.

Sean Armie: The future is now. Future's already here. Zach, one of our producers here, he's like 22 years old and he doesn't remember a world without Facebook.

Arun Divakaruni: That's scary to me.

Sean Armie: Yeah. I showed him a VHS the other day and he had no idea what he was looking at.

Arun Divakaruni: Zach, did you know what a VHS was? Zach is nodding.

Sean Armie: I know that mixed reality devices have have taken off. Here we use the Microsoft HoloLens.

Arun Divakaruni: Yeah. It's cool.

Sean Armie: But it seems like the old paradigm like brochures and handouts are still in place. We still have robust sales force requesting programs. Do you see any of these technologies fully disrupting the structure of how we execute peer-to-peer marketing?

Arun Divakaruni: Maybe disrupting is not the right word. I would say how do we augment stuff, and how can we use technology? Technology is supposed to help us. Right? You brought up the example of Facebook. That's a great example. The reason is that I remember a world where Facebook didn't exist. Facebook is a really great example of ways where on one hand, now I can stay connected to my family and friends from around the world, and that's awesome. On the other hand, there is a whole other sort of maybe dark side of technology too. For marketers, I think what that means then is that we have to embrace the technology insofar as it helps us achieve our communications goals.

You brought up mixed reality. Mixed reality is great in the sense that it allows us to visualize and see and experience things in a way that's akin to if we were doing it in real life. So I can see how a particular drug works. I can bring the cell to life within the context of this room. We can see how these different pathways may be effected and it sticks in my brain better because I've actually experienced it and I have not just read it on a page. So it works as a very effective learning tool. Likewise, doctors are human beings. They vary in age and there are doctors today that are practicing who also don't remember a world without Facebook. When you look at these HCP social networks, like Figure 1 is one for example, that's very sort of picture focused and reminds me a lot of Instagram. That opens up new avenues of communication. Our heritage in peer-to-peer communications is one that's sort of based in the Socratic method of teaching and how doctors tend to learn. It's a very authentic place to introduce new concepts and ideas to physicians.

Arun Divakaruni: What we've learned from, I think our colleagues who do consumer marketing, like the folks selling consumer packaged goods or other things, is that when it comes to success on these social networks, authenticity is key. That's why I'm very excited to be here at Avant and kind of one of the reasons that I came here is because I believe that as we become more digital, as technology starts to play an even greater role in marketing authenticity on the authenticity that peer-to-peer offers allows us to be successful in taking advantage of these new technologies to reach our audiences and help them understand about what our clients are doing and pushing the boundaries of science and medicine.

Sean Armie: All right. Regarding machine learning and AI.

Arun Divakaruni: Another buzzword. We're talking about all the buzzwords today.

Sean Armie: We're talking about all the buzz. We should rename the podcast Buzz Word Palooza. How are clients using these technologies, and what can we do to assist the big data crunchers?

Arun Divakaruni: Yeah, I mean that's a really good question. It's also important that we define what these buzzwords mean, like artificial intelligence. Have you seen Terminator 2?

Sean Armie: I have.

Arun Divakaruni: Okay. So in Terminator 2, Skynet comes alive and all of a sudden decides that humans are bad and all hell breaks loose. Then the movies got worse after the subsequent ones.

Sean Armie: We're not going to talk about those.

Arun Divakaruni: Right, we're not going to talk about those. Are we talking about like are we there at the point where artificial intelligence is a sentient machine? I think that's how a lot of people sort of think of it. Or I think what the more apropos definition is when does the computer do something that's sufficiently impressive? For us to go like, "Oh, that's really interesting." Then in so far as to say is like, "Has the computer figured out a way to solve the problem that we don't know about yet?" That's kind of that gray area where I think in certain industries we're there.

But in healthcare, the ability to use a computational power to assess large data sets and find some insights out of those is really, really exciting. There's a couple of different ways that that's being used in the industry. One example is in taking all the information, the health information that we have around, let's say patient outcomes in cancer and using that to bring all of these patients together to sort of find an insight.

I'll give you a more practical example. Let's say you have a 55 year old man in San Francisco who's diagnosed with stomach cancer. Let's say he had some cardiovascular comorbidities, diabetes, something. They receive a particular medicine, and we have that information about how this person did. Now, what happens if there's somebody in Florida who kind of has that same rare form of stomach cancer? Is the doctor sort of guessing on like, how should I treat this patient? Or can they look to a consolidated database that has maybe seven or eight of those different patients, shows what medicines and treatments that they've got, and what those outcomes were. That's kind of the goal and what we need to do as an industry is better collect that data and put it to work.

Another area I think that's kind of interesting is like looking at scans. Can we have the computer look at either CT scans to diagnose a particular disease? There's some evidence to suggest that the computer can do so at the same level as a reading physician. We were talking about until we have tons of genome sequencing stuff now, data now, the cost of sequencing a genome during the Human Genome Project was in tens of millions of dollars if not even more. Now a company down in San Diego, Illumina, is claiming to be a couple of years away from the hundred dollar genome.

Sean Armie: Wow.

Arun Divakaruni: With all of that information, there's no way that a human being can process it. How do you figure out what the role of AI machine learning, all of those sort of things, are to be able to understand that information and capture it into an actionable insight? Can we use natural language processing to look at what's happening on Twitter by the way that people are describing their symptoms to figure out where the next flu outbreak is going to be? Well, now we're living in this new coronavirus time. Are there ways that we can use things like natural language processing on public social networks to figure out maybe where that next outbreak is going to be, and hopefully we can shut it down before we would need to use that. But it offers tremendous amounts of potential.

Sean Armie: Yeah. Lots to think about.

Arun Divakaruni: It is. It's cool stuff. Really cool stuff.

Sean Armie: Final question. What's one thing in medical marketing that nobody's talking about that everybody should be talking about?

Arun Divakaruni: I don't know if no one is talking about this because somebody always talking about something, but one thing that I think is lacking a bit is remembering that a doctor is a human being. If they're a human being... I was having dinner with an oncologist at MSK the other day. One of the frustrations that he had was that when it comes to marketing and biotechnology and pharmaceutical marketing and stuff like that, it's all very clinical, and that stuff is important. But that's only half the picture. This doctor, he likes to go home and watch Game of Thrones. He likes all of that. He's just a human being. I think we're at an advantage here where we can look to see how our friends in the consumer marketing space have taken advantage of natural human behavior, how they interact on social media, those sort of things, and bring their customers something of value.

When we bring something of value to the person that we're talking to, they will reward us with their time and their attention. Their doctors are busier than ever before. When we can lean into and understand them as a person, what compels them? What makes a good story? What makes somebody... Why does this oncologist who has tons of patients gets like an hour out of his day to maybe relax and spend time for himself? Why does he choose Game of Thrones? It's because it tells a pretty good story, and he likes that story. I think we can sort of lean into that and maybe embrace our humanity a little bit more when it comes to medical and scientific marketing.

Sean Armie: All right. Well, thank you so much, Arun.

Arun Divakaruni: Awesome. Well, thanks for having me.

Sean Armie: I think this was a good first podcast.

Arun Divakaruni: Cool.

Sean Armie: For everyone listening or for everyone watching, please go to our website to sign up for our newsletter to get more updates on what we're doing in our blog posts and learn a little bit more about us. Again, thank you so much, Arun.

Arun Divakaruni: All right. Thanks for having me. This was awesome.

Sean Armie: Thanks.

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