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Is Evolutionary Biology Hijacking Your Advisory Boards?

Overcome barriers on both sides of the table that can constrain the relevance and authenticity of advisor input, differentiate between decision-validating and decision-guiding insights, and transform advisory boards from transactional projects into strategic investments. 

Webinar Transcript

Todd Wright: Good afternoon everyone. Thank you for joining us for this webinar. We know how precious your time is, so we're going to try to keep the presentation so about 20 minutes today. Then we're going to open up the mics or open up the Q and A session via the chat for the final 10 minutes. Hopefully the mystery and intrigue behind our title, Is Evolutionary Biology Hijacking Your Advisory Boards, will make a stance here in the next few minutes. But first we want to take just a short moment to introduce ourselves. My name is Todd Wright, I'm a Senior Vice President here with Avant Healthcare. I've been with Avant for about four years. Prior to joining Avant, I spent 11 years working for a large fortune 100 pharmaceutical company, doing stance in both sales and marketing. So I've had the luxury and privilege of actually being a part of advisory boards from both the client side, as well as the agency side now. So I certainly look forward in sharing some key learnings with everyone on the webinar today.

Sean Markwardt: Hi everyone, my name is Sean Markwardt. I am a Medical Director here at Avant Healthcare. My academic background is in neurobiology, so some of the things and concepts we're talking about today are pretty near and dear to my heart. I've been in a variety of roles in the medical communications area of pharma for the better part of seven or eight years now and spent the last four with Avant Healthcare. Having the opportunity to be involved in a variety of different roles for advisory boards for many clients, many therapeutic areas on both the commercial and medical side. So I look forward to sharing some insights with you today.

Todd Wright: As you can tell by our pictures, Sean is the brains and I'm obviously the beauty of the bunch. So keep that in mind as we're going through the presentation today.

Sean Markwardt: Thank you, Todd, well said. Okay, so don't be alarmed, I promise you are in the right webinar. But you also might be scratching your heads about why you're looking at a piece of lasagna during a presentation about advisory boards. We hope that this consumer packaged goods vignette might give you some insight around our central thesis today. So I'm sure that everyone is familiar with the brand Colgate, right? The toothpaste and oral hygiene brand. So the story is that back in the 1980s they were looking into areas to diversify revenue streams by increasing product offerings. And to make a very long and painful story short, they ended up with a line of frozen dinner entrees.

And surprise, these products were actually pulled from the shelves less than six months after they had launched. So part of the lesson here is that there's no way that Colgate did not take this product through some of focus group in making the decision to actually bring this product to market. Now we're not suggesting that the consumer packaged goods industry is a 100% analogous to pharma obviously. But the market research and focus groups, the corollary of advisory boards, should serve some very similar purposes for pharma, which is to serve as a checkpoint for product development and marketing efforts.

And so what went wrong here? The lesson I think we can learn from lasagna is that the people at Colgate, either one, did not design their market research and focus groups or advisory boards in a way that would produce the most accurate insights or two, that they didn't hear what their potential customers were actually saying. So over the next 15 minutes or so, even though we could spend probably a couple of hours talking about some of these topics, we just want to give you some ideas, insights, and relevant questions to ask about overcoming barriers on both sides of the table.

So the barriers that advisors bring with them, consciously or not, and the barriers that your team on the pharma or biotech side of that advisory board table may have again, consciously or not, in delivering the most useful and authentic feedback that will help meet your objectives. And second, what do we mean by decision-validating and decision-guiding input? How do you differentiate between those two? Why is it important? And how do you incorporate those topics into your advisory boards?

And third, we hope to offer some suggestions for transforming your advisory board initiatives from transactional tactics into strategic experiences with longterm value. So what are some of the barriers of the brain? Our whole premise of this presentation and the way that it has to do with evolutionary biology, is that the human brain has evolved to implicitly store predispositions, prejudgments, biases, and overarchingly 95% of the things that we say, we do, or pay attention to is really driven by parts of the brain outside of the neocortex. Meaning that most of our behavior, whether we like it or not, is unconscious.

Now, the good news is that we don't have to change any of that. We can't really. But the good news is that you can make a point to recognize it and also take steps to manage it. So we want to spend a few minutes describing some of these unconscious biases and behaviors and how they relate to the authenticity and success of an advisory board. Because if you don't get authentic feedback, you could be making decisions based on error data or biases. And the first one is this idea of forced feedback.

So you may have advisors for just a few hours or sometimes if you're lucky, for a day or a day and a half. And so you want to get their opinions on as much as you can, as many topics as possible. But you're putting something in front of them that they're not used to thinking about? They might see it, they might touch it or even use it in their daily practice, but that's just habit, driven by the unconscious brain. And so are they really, truly thinking about it. So to give an example again, outside of pharma or biotechnology, a baseball cap.

That's something that a lot of people might use on a regular basis. They see it, they touch it, they put it on and take it off. But do they ever really think about the hat? So suppose you're a hat company and you're looking to innovate your products, right? So you get a focus group, a hat innovation advisory board, let's say, to ask them about how they might innovate your product. For the first while at this advisory board, they don't say much. But you really need to get feedback from them. So you start pressing them, think outside the box, what does innovation look like to you? And so on and so forth.

And your advisors really start wrecking the brains because after all, you're paying them to be there and for their ideas. So your advisors come up with this. This is one of the 25 worst products of all time listed by multiple websites. And I don't think that, that's much of a surprise to any of you because the hat didn't need this kind of innovation. And because the feedback that you forced them to give you about something that they don't routinely think about with the executive brain, the conscious part of the brain, that creative feedback that was not authentic and certainly not appropriately guided.

To give an example from pharma though, I was recently at an ad board for a biologic product, so it had to be delivered with a self injector. Our client spent the better part of 90 or so minutes asking physicians about their thoughts on the auto injector. They didn't have much feedback, except for it's okay or it seems to work fine. But our client was really pressing for input on the size, the weight, the sturdiness, the clicks and the twists. Not surprisingly, they ended up with a lot of feedback from those advisors about all those things and more on top of that. But when they thought about it, if they were going to incorporate all this feedback and take all the advisor's input into account, the engineers would have had to start from scratch and build something that looked completely different.

And there was absolutely no intention going into this advisory board to actually change the auto injector device in any way. And so that 90 minutes could have been spent on a better purpose. Okay, so besides forced feedback, there's a few other things we wanted to mention and define that may end up affecting your advisory board and the authenticity of feedback that you got from it. So for the advisors, on their side of the table, there's social proof or herding. And so what that means is that in a few or all of your advisors, may be in agreement with another one or two of those advisors, only for the sake of being in agreement or having been easily convinced not because it's what they truly think.

And so this happens unconsciously because of differences in status potentially. So for example, if you have a chief of a department or a nationally recognized thought leader sitting next to a more regional or local advisor, or even because of a difference in how confident one might sound or the volume of their voice. And so all of these things may contribute to social proof, which a different term might be called group think. So one way to mitigate this, I'm going to give this to Todd.

Todd Wright: Yeah, I mean, so the best way to mitigate social proof are herding is to or group think is for the brand or the medical team that's putting on the advisory board, to do some pre-work. Really understand the personalities, the attendees, the tendencies and the interests of your advisors when selecting those individuals to attend the advising event. So once you understand this, their background and everything that's kind of in their experiential base, then you can use this information to tailor the day's events to encourage the most authentic feedback possible without having group think.

So for example, you may tailor your breakout sessions within the advisory board in a way that you have people with different backgrounds, different interests and different experiences attending these breakout sessions in groups, instead of having several folks that are very much similar in those aspects in the same breakout. Another way to mitigate this is going into it, understand what feedback is best received verbally and what feedback might be better suited for say, written or anonymous feedback. That way you're able to get like truly unbiased opinions from your advisory group because nobody would be shy to either speak up or be fearful that, that strong personality is going to overtake the conversation in any way.

Sean Markwardt: And then there is availability bias, which is the tendency to think that examples of things that readily come to mind are more representative of reality than they actually are. So let's say you're having a discussion about injection site reactions and one or two advisers had just seen patients with a severe injection site reaction yesterday in their clinic. Those advisors, who had just seen that thing recently, might be overstating or have a bias about their opinions towards injection site reactions for your product. Even though your data says that injection site reactions only happen a very small percentage of the time. But you're now taking feedback from those advisers, who have availability bias because they had just seen it in their clinic yesterday.

Todd Wright: Yeah, so I think one of the best ways to avoid availability bias, once again, is pre-work by either the brand or the medical team that's putting all the advisory board. And this time the pre-work is really more around identifying which questions might invoke such a bias and be prepared to ask further questions to clarify that. So in Sean's scenario, this may be as simple as asking, "Well, when was the last time you witnessed an injection site reaction?" Or maybe, "How many times in the last month have you seen an injection site reaction?" So once you get that context, it's better for you to then process the meaning of that feedback, as well as redirect the conversation in the way that it needs to go versus a one off random, if you will, type of an event.

Sean Markwardt: And that that additional questioning really expands the window of time in which you're thinking about particular things. So it becomes less of an issue across the greater span of time that you're inquiring about. So status quo bias, this is an emotional bias and I think you might recognize this one. So this is the idea that what is being done in practice right now is the baseline and any change from that baseline is perceived as a loss. So this is very analogous to change management, right? So are you having an advisory board with the first in class product that targets and unfamiliar protein in a disease area that hasn't seen a new drug therapy in the last decade or two decades? That's a long baseline to have to overcome. So how do you tell which of your advisors, Todd, are more likely to come to your advisory board with this status quo bias?

Todd Wright: Yeah, I think the best way to manage this, I hope you're definitely seeing a theme here, right, is pre-work by the brand or medical team. Really think through who all is going to comprise your advisory board before contracts with those individuals. So you want a good mix, you want folks that have a lot of experience, kind of seen as those long time key opinion leaders. But then you also want a nice blend of those new and emerging physicians, right, or practitioners to commingle with the ones with a lot more of the deeper experience. What this is going to provide to you will be more authentic feedback across a broader experiential base from your advisory group.

So we are going to now flip to the other side of the table and let's talk about the bio pharma side. And when we do this, let's be really honest with ourselves because I can tell you from experience, I am pretty sure I've committed pretty much every one of these next items that Sean is getting ready to discuss. So in order for this not to happen, the brand or medical team really needs to keep these things on top of mine because the advisor side are things that we can address from a pre-work perspective, these are things we need to address pre, during, and post advisory board activity.

Sean Markwardt: So the first one I think is a big one and that's confirmation bias. So when you're preparing for an advisory board, really ask yourself and your team the question, are you only going to this advisory board or having this ad board to hear the things that confirm what you already think and believe and discount or discredit anything that comes up to the contrary? So this requires some self-introspection, are you really open?

And if you are not really open, why are you bringing this to the advisers? So the sunk-cost effects, continuing behavior as a result of previously invested resources, is the sunk-cost effect or also called the sunk-cost fallacy. So an example again from outside of pharma, I can relate and I'm sure Todd can relate, as somebody who may overeat after ordering way too much food. I did it last night, I ordered way too much sushi, but I ate all of it because I had a sunk-cost in that sushi, right?

Todd Wright: I have no idea why you put my name in there, I really don't.

Sean Markwardt: So doing that is an example of sunk-cost effects. And so are you bringing a project to an ad board that maybe has been going downhill or there's, there's decreasing interest in it as a team? Are you bringing that to an ad board in hopes of reviving it, just because you've already invested so much time in so many meetings and a lot of people have been working on it and you've invested resources? Are you really bringing that because of the investment you've made or because it really has the potential to generate value for your team?

And then there's opportunity-cost neglect. So this is the tendency to ignore what's being given up when another choice is being made about how to use time, money and other resources. So in the example that I gave a few minutes ago about getting 90 minutes of feedback about a device that was never going to be changed. They didn't consider the time that they were giving up to be able to discuss a different topic or a different work stream or different projects. And so that time that they invested could have been spent a better way. But it was neglected due to opportunity-cost neglect.

And so in this next part we want to talk about decision-guiding versus decision-validating advisor input and why that's important. So this quote is quite a famous one. A lot of people attribute it to Henry Ford, although there's not a shred of evidence that he actually said it. But the quote I think is still relevant so, "If I had asked people what they wanted, they would've said faster horses." Whether Henry Ford said it or not is irrelevant. But the quote is relevant in our context because, and in our experience at Avant, there's a strong tendency a lot of times to want to validate as many decisions as possible through the customer and whether that customer lenses through the HCP or patients.

And so the question here is, what are the things that you trust your team, yourself, and your organization to get right? What are the areas in which you think and believe that you are truly the experts? Because without understanding that, putting those pieces of expertise in front of a advisory board may only end up confusing or paralyzing your team in moving forward instead of having a true innovation within your own team and your own expertise bringing something like that. So an ad board, you may only end up with the faster horse.

Todd Wright: Yeah, so I mean what we mean by decision-guiding versus decision-validating is when you're planning your advisory board, be very specific of which decisions have you not made. Therefore, the feedback you're soliciting from your advisors' going to guide that decision versus the decision-validating. And those will be the decisions, if you're going into this advisory board, that's already been made and you're looking to validate those decisions from your advisory group. Either way, be careful and be prepared to maybe get feedback that you don't want to hear, right? And so for those decision-validating topics, you really need to be truly open to hearing contrary input and then go back and do something different.

Don't just do an advisory board just to do an advisory board and check a box, right? But truly listen, listen to your advisors, so that you can be really prepared to go back to the drawing table and redirect or revamp those decisions that maybe that the team were either already inked to or leaning towards. So transactional, this is our last section. So transactional to strategic. We would be remiss if we didn't touch on the importance of moving to this very transactional experience with your advisors to one that's more strategic.

So what you see here is the traditional advisory board, right? You're in a huge U shaped room, conference room, probably in the basement or first floor of some hotel somewhere. The advisors are sitting in their chairs, reviewing a slide deck, a series of slides all day long, reacting to questions that you may be presenting to them. So if you've ever done advisory board, I know you're probably in this going, yup, looks and sounds very familiar. So what we have found to be the most beneficial way to really deepen the feedback we get, is take the advisers out of that traditional and sterile environment. Place them in an environment that stimulates them to think differently, right?

We don't have them sit in a U shape table. We like to get them out of their seats, put them in breakout groups. We switch the breakout groups up halfway during the event. Just to continue that engagement. We do try to select innovative spaces that allow both sides of our advisors' brains to be activated, right? Both the data side, as well as that creative side. That's going to be able to give us the deepest and richest insights we need to go back and inform our best decisions that we're engaging them on. So that is just kind of the key, one of the really high level, key areas of success we've come up with to turn these things from a transactional type of environment to one that we are able to get the deepest and strategic insights.

So with that we're going to, we're going to summarize what we've discussed today and then we'll open up for questions via the chat feature inside the webinar here. So in summary, unconscious behaviors and biases, they exist within all of us, not just with advisors, but also in our own team. So we need to understand that when we're developing the advisory board activity, when we're selecting who those advisors are and then any kind of accurate advisory board activity we will undertake.

Sean Markwardt: And the second one can can be difficult, right? Because you have a lot of topics, but our recommendation and what we've found a lot of success in, is driving the advisory board agenda by decisions, not by topics. And then third, think about how advisory boards and curating relationships can contribute to longterm strategic value. Instead of just accomplishing the boxes that need to be checked on your task list. So how can you take that value from that one advisory board and then pull it through with the advisors for some long-term value.

Todd Wright: Awesome, thanks, Sean. All right guys, I'm sorry we went just a little bit over on our time there, but we still want to open it up for any questions that you guys may have. If you have a question, just go to your chat function and submit a question via the webinar application.

Sean Markwardt: Okay, so here's a question that just came in. So the question is, how can you address some of these things that we just discussed in a virtual ad board versus a live one? We know the world is moving more and more virtually and there's expense associated with live advisory boards. So if you're not in person, how do you mitigate some of these things via the web?

Todd Wright: Well I don't know. I certainly have a thought here. Actually, I would say that you really wouldn't change much of anything that we just talked about, right? I mean a lot of the things that we talked about from the brand or medical side of the business involved pre-work. And it really involved thinking through what kind of business questions are we trying to get answered? Who are the right people to answer those questions and how can we eliminate a lot of these biases that Sean mentioned during our presentation? So I think the pre-advisory board, I'm not sure it changes much. Now during, obviously you have a completely different dynamic, right?

You're not having advisors sitting right in front of you that you can gauge their level of engagement. So virtually, you need to probably build your content around that advisory board in a different way, that's going to encourage and stimulate engagement through activities, polling, surveys, things like that, that's going to keep their engagement at the highest point possible throughout that advisory event. Now another thing, you're not going to have a four, eight hour advisory board virtually either, right? There is no way you're going to get someone to sit there and do that. So you also to think about how you streamline your agenda to accomplish what you need to get done in really that one to two hour time frame, that is going to be fast moving and action packed, but still very beneficial to what you're trying to get accomplished from brand or medical perspective.

Sean Markwardt: I think this is much more about awareness than it is what can I do or how is it different between live and virtual? If you design your agenda like we recommend by decisions that need to be made and then match that up against some of the biases that we've talked about and say, "Okay, which areas of our agenda might introduce some sort of bias?" And then being prepared to ask further questions. I think that really is the most powerful tool in addressing some of these challenges, which is just ask more questions.

And if you know the types of biases that might walk into your advisory board, you're better prepared to actually formulate what those questions to be that, to slowly start to remove some of those biases that are unconscious. This is not a purposeful bias that is brought in by any advisor and that's the whole point of the evolutionary biology aspect of this, which is this is the way that the human brain evolved and we're going to fix it. But asking the right questions and matching that up with your ad board strategy is the way to manage it.

Todd Wright: Hope that answered the question. We are right at, I think one 1:30 right? So with that, we're going to shut down the webinar. Thank you guys so much for the time today and your attention. If you have any questions, please feel free to reach out to me. This is my email address here on the screen and hopefully you got some value out of Sean and I's presentation today. With that, we wish you all a great Wednesday and a fantastic rest of your week.

Sean Markwardt: Thank you all for joining, appreciate it.

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