Podcast Transcript

Sean Armie: Hi. Welcome to Connecting the Dots with Avant Healthcare. I'm your host Sean Armie. Today our guest is Sean Markwardt, who is director of our medical affairs business here at Avant Healthcare. Sean, how are you today?

Sean Markwardt: Well, first of all, it is going to be difficult. The two Sean's. We're going to have to come up with designations for ... Obviously your last name is much cooler than mine is Armie, Markwardt. A. Anyway, I'm doing great, Sean. Thanks. How you doing?

Sean Armie: Oh. I'm doing fantastic.

Sean Markwardt: All right.

Sean Armie: To start us off, Sean, tell us a little bit about yourself. Where'd you come from? What gets you out of bed in the morning? What inspires you to do what you do?

Sean Markwardt: Where did I come from? There could be a lot to unpack there, Sean.

Where I came from was not Indiana, although I've really enjoyed living in Indiana. I grew up in Philadelphia. I came from a family of extremely intelligent and hardworking people. My father was a carpenter and he's a commercial construction manager. My brother is also a carpenter and an architect and also firefighter.

Sean Armie: Oh, wow.

Sean Markwardt: My sister is an interior designer.

Sean Armie: Wow.

Sean Markwardt: Then you have me who went to science school to figure out how individual brain cells talk to each other. Not black sheep, but I probably took a little bit of a different path than others in my family have. I spent some time in graduate school in Alabama and moved back to Pennsylvania and I spent some time in clinical neurophysiology and had been working in medcoms for about a decade now and have found myself in Indianapolis.

Sean Armie: Awesome. Well, we're glad to have you. The topic today is medical affairs. I know that for a lot of us, medical affairs can mean different things, from company to company, medical affairs is different today than it was just five years ago. Help us define some terms. What is medical affairs? What does it mean to you?

Sean Markwardt: Yeah, so I'll try to define medical affairs, not by the things that they do or the things that we do with them or for them, but more in terms of the purpose of medical affairs, because I think the purpose remains consistent from organization to organization, but the things that occur as a result of that purpose, depending on what therapeutic area we're talking about could be a bit different. The purpose of medical affairs, and there's a bit of an evolution to keep track of here, back in the day when medical affairs originated, it was a result of a need for a checks and balances system on pharma, as I'm sure our audience knows and you and I know. Pharma ran amuck for a little while. Medical affairs in addition to some other reasons, partially originated because there needed to be some medical and scientific integrity added into the pharma development and then commercialization process.

The reason that we're talking about medical affairs changing is because they are uniquely positioned as an organization or business unit who has deep roots in science to really be able to communicate the things that are of the most value considering today's complexity of treatment and specificity of drug targets that aren't so well captured on a sales aid. We've long passed the days of giant blockbuster drugs that treat millions or tens of millions of patients. Now we're looking at smaller segments of patients, really starting to actualize the prediction from a decade ago of really personalized medicine. The fact that it's becoming more complex, really positions medical affairs in a way to to hold and carry that conversation forward versus the commercial marketing sales organization.

Sean Armie: You recently gave a talk at Mass West, which I believe is the Coachella for the medical affairs community?

Sean Markwardt: That's a bit of a leap, but I'll take it.

Sean Armie: It's a bit of a leap. Okay. You didn't, you didn't wear any beads or I'm guessing you were ... I'm kidding. In your presentation, you defined what you call the complexity gap, which is the idea that social, technological and cultural reality evolves at a faster rate than human institutions. How would you define the complexity gap as it relates to pharma and what are the social, technological and cultural realities that pharma needs to catch up with in order to remain relevant and successful?

Sean Markwardt: Yeah. Again, a lot to really unpack there. I didn't call it the complexity gap. Many people who are smarter than I have called it the complexity gap. In the context of pharma, it doesn't need a different definition or redefinition. The definition really remains the same. What I can do though, is give some specific examples of how the complexity gap applies to pharma or applies to medical affairs. That definition of how people operate, how you and I conduct and go through our daily lives, wake up in the morning. We're probably turning off our alarm clock that is on our iPhone. We go downstairs. We make a breakfast that we pull up a recipe for on our phone. We check Instagram then Snapchat. What we don't do in our normal lives is wake up and open up a PowerPoint presentation.

Sean Armie: That would be very weird.

Sean Markwardt: Right. That really, I think, illustrates what the complexity gap is for pharma specifically in medical affairs. Again, you and I know, that a lot of our business and the things that we do and the consult and advice that we provide to our clients, a lot of times applies to PowerPoint slides. In medical affairs, especially when you have medical science liaisons, medical outcomes liaisons. Going to individual customers, they need a presentation platform. I get that.

We all get that, but the gap is still between what we are doing the majority of the time in terms of solutions and how people actually live their lives. That PowerPoint example is one. Then if we dive a little deeper into the PowerPoint piece of it. As I said in my Mass West talk earlier this week, there have been dozens, if not hundreds of actual scientific studies, whether it's optic tracking or cognitive load experiments or FMRI, they all unequivocally say that putting a PowerPoint slide in front of somebody that has 500 words on it and six graphs does not resonate at all.

I think a lot of our clients are making some progress in that particular department, but the other thing I'll say is we attended the Medical Affairs Professionals Society meeting earlier this year, and sitting through the sessions and listening to attendee questions and comments, it seemed that medical affairs was almost resigned or had given up on having slides that were compelling and easily understandable, because if you don't have that, then it seems less scientific. The argument that I made in the Mass West presentation is that it doesn't have to be that way. You have things look and feel and resonate as being scientific information, but at the same time appealing to the things that make us human and not overloading the prefrontal cortex with more information than it can possibly comprehend.

Those are some acute examples of what the complexity gap looks like for pharma, what it looks like for medical affairs. The other comment that I made in the Mass West presentation was about pharma as an industry is probably a decade behind any other industry. Looking at pharma specifically, medical affairs could possibly be five years or even 10 years behind what their commercial marketing colleagues are doing. For medical affairs and what the role they play is in this is really taking into account what human beings are drawn to. What makes things easily understandable to them, putting things in context. That leads me to also make a comment about our approach here at Avant Healthcare to medical affairs is not just understanding the science. That is above all the most important thing that we need to do.

In addition to that, we also need to consider how we understand the context in which that science is being communicated, and then also understanding the people to whom that information is being communicated. There's really a lot more to medical affairs and just understanding and communicating science and data points, and being able to provide clinicians and patients and payers with the appropriate information in the right context, and considering who they are and how they operate. There's a whole lot of complexity in healthcare and there's there's room for improvement. I think the complexity gap could be, again, not a term coined by myself or discovered by myself, but could be a central focal point for how we start to address that in our own context.

Sean Armie: In terms of addressing this complexity gap, can you give me some concrete examples of things that you've seen medical affairs teams do or things that you think they should be doing in order to address it?

Sean Markwardt: Yeah, there's a ton of opportunity. I think there's a little bit of reticence because anything that is new and this is true of human behavior, this is not just true of medical affairs or pharma, but it's true of humans. Anything that is new or seems risky or is not familiar. There's not necessarily an aversion to it, but people need a bit of an on-ramp so to speak. I understand that, especially considering the regulatory legal environment in which we operate, but I think a really good example. Again, one that I presented during our Medical Affairs Strategic Summit presentation is just the digital space. This is extremely relevant considering the last nine months that this country, the entire globe has been through. Mobile and digital platforms that existed, or maybe even didn't exist prior to COVID-19, have seen a tremendous influx of physicians joining those platforms to get the most relevant, the most up-to-date information.

Honestly the most authentic because other physicians and other healthcare professionals are there. We know that that's one thing that physicians value is learning from each other. We recently did an advisory board this summer related to field medical and COVID-19, and the changes that have happened and how we plan on reintegrating after the pandemic is over. Some of the feedback that we heard that really has stuck with me for at least three or four months now, is that there are sources of information that you may not think of. If you're somebody working in pharma that you may not think of that physicians are going to, to get information. But one physician advisor said that he was going to Slack to get information from a rheumatology group where he knew some of the individuals that were in there, and he trusted the information.

What he said was to our client, the pharma company was, "Don't let channels like Slack take over the value that you inherently can provide us." Slack is probably not the best example. There are other HCP channels that are extremely active. Have thousands, tens of thousands of HCPs active daily. They're interacting with these platforms while they're preparing for their day. If they're looking at case studies. If they're looking up drug information and dosing and adverse events at the point of care, a lot of these channels exist. I personally have not seen a whole lot of medical affairs organizations going to meet their customers on these particular channels. I'm not saying it doesn't exist, but that's an example of one of the big opportunities that I see is being able to provide smaller bits of content, of data, of information, the ability to have peers teaching, teaching their colleagues on digital channels that are already somewhat habits for HCPs, especially that we are a little bit personally disconnected since March.

That's a big opportunity. Things that we have seen where you wouldn't necessarily expect medical affairs to be playing is augmented reality. If you told me two years ago, or three years ago, that that we would be providing augmented reality solutions for medical affairs teams, I would've said you were crazy, and that was a solution that we thought about before COVID even hit. This was a conversation that at the end of last year, but it's really exposing the connection gap that we have now, and things are not going to in our estimation go completely back to normal. These are some of the things we can do to address how things have not just changed, but how things will persist in our environment. I hope that gives at least a little bit of a snapshot into some tangible tactics that can help close that complexity gap.

Sean Armie: Yeah, well, that's perfect. Because that flows right into my next question. In my observation, it seems like the ... Not only are these digital technologies, these new platforms, these new channels. Not only are they new opportunities for medical affairs and pharma and marketing and, and well, I mean, everyone. They are new opportunities for everyone to get their messages out, but they're also kind of extremely disruptive to the traditional structures of power in and outside of medicine.

If you think about social media. Obviously, if you're a powerful institution with lots of funds and you can play the algorithm and invest in ads and things like that, you do have a bit of an advantage, but theoretically, if you are an individual physician and you post the right content that people find engaging, and you connect with all the right people amass a followers, you can have as much influence on Facebook or SERMO, or Doximity as a major pharma company, or a major medical journal. This is, I think this is something that we're all kind of coming to grips with. My question. Yeah. My question is, is that, how do you think medical affairs is well-positioned to navigate this sort of changing structure of, of power and influence in this new digital age?

Sean Markwardt: Yeah. When you say, Sean, changes in traditional structures of power, I'm reminded of a quote from The Office. One of my favorite TV shows. Where Michael Scott is talking about Wikipedia and he says, "Wikipedia, literally anybody can go post anything about any topic. So you know that you're getting the best information available." Which watching that episode in 2020 is probably funnier than it was when it was originally aired. I think that the change in the power structure that we're talking about is power of people and power of access and power of availability, power of distribution. I mean, this is I think how the term social media makes sense because we're now getting information and data or stories, not from the news media, but from our peers, or from society.

Again, I think we could probably spend an hour or two hours or three hours talking about the net positive or net negative effect of giving power to the people and giving greater access and availability of information because you get into, well, what about this information and how do we ... That leads into I think what the value of medical affairs in this particular space is, which is authenticity and trust. When you have much more information available and many more things that are accessible, that didn't used to be accessible. Now it comes down to, "Well, out of these thousand different sources that I hit information from, which of them do I trust the most?" I'll go back to that physician talking about Slack.

The reason that he trusts Slack is because he knew people that were on that platform and talking about rheumatology practice and how best to treat a particular kind of patient at a certain point of their disease. It's incumbent upon, or at the very least an opportunity for medical affairs to really demonstrate the authenticity of the information that is being provided. That's where I'll lead into potentially a whole other topic, which is about the evolution of medical affairs. There are many aspects to this. Talent being one of them. How medical affairs is positioning information that is not just for information's sake. Back when medical affairs originated, it was more of a support position and a regulatory or internal governance position. This, I think, is one of the fundamental changes in medical affairs that we need to take heat of, which is understanding science and understanding how to communicate scientific and clinical data is not enough anymore in reference to authenticity.

That's very dependent upon trust and relationships. If you have a medical science liaison, for example, their ability to read a New England Journal of Medicine article is no longer the bar for excellence in field medical. Just for example. Again, I'll go back to the advisory board that we held this summer, which was about the value of field medical in the eyes of physicians really was centralized around that trust and that relationship, not in the ability to know exactly what data point existed for this clinical trial or for that endpoint or what the P value was for this or for that. It was the comments that resonated were about the individual MSL and physicians saying "I don't see this person as an employee of Genentech, of AbbVie. Of Novartis."

It was they were saying that the value of that individual came from the relationship that they had. I think we've seen a lot of our clients placing a lot more emphasis on the value of those relationships versus just the scientific clinical information exchange. If we're talking about digital and shifts in power or shifts in streams or channels of information. What remains important is authenticity and knowing who and what to trust about what subjects or topics.

I think that really speaks to the opportunity for medical affairs. To really be focusing on first the relationship and understanding what individual value physicians and other HCPs get out of pharma companies. Just to sum it all up. Authenticity and the premise that medical affairs is not there to influence or to market, or to create awareness of a product. It's about providing the most helpful context around a therapeutic area or a product for a pharma company. That trust and authenticity is something that is very difficult to achieve with a PowerPoint slide or a leave behind brochure. That's how I believe that medical affairs is well positioned to enter this new era of how information is both created and consumed.

Sean Armie: You mentioned the PowerPoint slide, and you mentioned the leaflet. How important is design to medical affairs right now? I know you got to communicate authentically, but also communicate with authority, right? Like you got to know what you're talking about, but sometimes the way we do that is we hand people these over complicated things that look like package inserts or important safety information. Yu just expect them to say, "Hey. Here. I'm sure you'll take away the key messages." How important is design for medical affairs and communicating value?

Sean Markwardt: Our Chief Executive Officer and Chief Science Officer has given a presentation at least internally here and has talked about some related things. One of the things that I remember from that talk was about how Jeff Bezos said, and I'll leave out any net positive or net negative effects of Amazon on the world. I think there's at least one thing we can pull from this Jeff Bezos quote, which is to say he's often asked the question, "What's going to change in the next 10 years. And how was that going to address or, or change your business strategy?" What he says in response to that is, "I'm very rarely, or perhaps even never asked the question, 'What is not going to change in the next 10 years?' And that's actually the better question to better address business strategy, is around things that are not going to change."

What Arun says or what Jeff Bezos says applied to our environment than our business, our context is that one thing that we are very certain that is not going to change is that HCPs will continue making decisions as human beings. Healthcare professionals are not going to be replaced by robots. What that means and Arun has talked about this. I mentioned it in the Mass West presentation earlier this week. What that means is that HCPs, physicians, nurse practitioners, physician assistants, nurses, are susceptible to the same exact human biases and preferences and cognitive heuristics that you and I are susceptible to when we're scrolling through Instagram in the morning over breakfast, right? About design specifically it, again, going back to the overloaded PowerPoint slide, that is not the best way to communicate information to a human being.

We're not feeding that data into a machine to make decisions for patients. We have to acknowledge that design is not about making something look pretty. Design is about appealing to human cognition, the basal forebrain, and what is going to attract and hold attention, and also be understandable. Putting things in context for a particular individual. Design, if there's a bad rap about design, it's that well, it looks promotional, or it looks like it's marketing, or it looks too simple to be scientific. These are some of the challenges that may exist in medical affairs and trying to keep separate from what commercial organizations or what marketing organizations are doing. Design is not about marketing. Design is about understanding and acknowledging how the human brain works.

Sean Armie: I just want to thank you so much for your time. I want to ask you. Pretend I'm a skeptical brand lead or a C-suite executive at some pharmaceutical company, and I'm listening to everything you're saying right now. What I'm hearing is a lot of risk. I'm hearing a lot about, "Let's try some new things and we got to be doing new things, and we got to close this gap that ..." I'm kind of overwhelmed. I'm like, "This is all well and good, but man, I got so much pressure from compliance and regulatory and legal. I mean, I can't afford it." Just try to bridge the complexity gap until I know that there's a hundred percent sure far away of doing it. How do you address this person's anxieties?

Sean Markwardt: Yeah. That's a great question. I'll start with something I said a few minutes ago, which was about the inherent skepticism or reticence that human beings just have naturally. Again, I'm academically trained as a neuroscientist. I always go back to how the human brain works and how it has evolved. One of those fundamental things is about being resistant to change. This has a whole lot of evolutionary reasons and we don't have time to get into, but that there is an inherent resistance to change and that's okay. I think what I said a few minutes ago was that you'll wait for somebody else to do it, or, or for someone else to lead the path and that's okay. I don't have a line of communication to every pharma organization, so I don't know how things work inside of every pharma building.

There may be situations where it is better to let marketing do something first, and then figure out how to adapt it to medical affairs and what protocols and guidelines and overall appetite for new things is. I also think that's why there's a big opportunity for medical affairs to differentiate themselves is by being the ... I don't like the word risk, but for right now, I'll say a being the risk taker in doing something different, because you probably know that many of your medical affairs organization competitors in a particular therapeutic area are probably thinking the same thing. That's where an opportunity for differentiating your field medical group, your strategic medical affairs organization. That's an opportunity is to be different, to be the first to do something. As it relates to risk.

Like I just said, I don't like to say risk. I think it's about making sure there's an appropriate evaluation of benefit versus risk. There are plenty of regulatory and legal professionals to help navigate those discussions. I think the bigger risk in not trying to meet some of these social, cultural, technological demands or advances is falling behind. We can talk about the risk of doing something new, but we also need to consider the risk of not doing something new and not meeting medical affairs customers in the context that we can help provide HCPs. What not doing something is, or how that is posing risk to what we are trying to accomplish as a medical affairs organization. To that executive, to that brand manager, to that therapeutic area lead, I simply would say, it's easy to talk about the risks of doing something. Let's make sure that we're also considering the risks of not doing that thing.

Sean Armie: All right. Well, thank you so much, Sean. Take care and stay safe.

Sean Markwardt: Thank you, Sean. A. Appreciate it.

Sean Armie: Oh, thank you. Have a good one.