Podcast Transcript

Marc Iskowitz:

Hi. This is Marc Iskowitz. I'm Editor-at-large for MM&M, and I'm super excited to be part of this episode of A100 Story Cast, the new podcast series which gives members of the MM&M Agency 100 list an opportunity to expand on what sets them apart.

Marc Iskowitz:

In this episode, we're focusing on the agency, Avant Healthcare, and drilling down into the agency's unique ecosystem approach to meaningful and effective engagement with healthcare professionals.

Marc Iskowitz:

I'm delighted to be joined by Avant's CEO, Arun Divakaruni. Arun, how are you, and welcome to MM&M Story Cast.

Arun Divakaruni:

I'm doing great. Thanks, Marc, for having me.

Marc Iskowitz:

Absolutely. It's my pleasure. We've written much about at MM&M about how the pandemic impacted industry's ability to connect to and communicate with the healthcare professional, and we know that COVID-19 changed everything for everybody, but tell me. From your point of view, Arun, how has COVID affected the way you communicate from your agency's perspective with HCPs?

Arun Divakaruni:

Yeah. That's a great question. Obviously, the pandemic has completely upended a lot of the ways that we deliver healthcare, both in the acute setting with folks who have gone to the hospital with COVID and COVID-related symptoms, but then also with how people have perhaps avoided or changed their own medical care as a result to being in the hospital itself.

Arun Divakaruni:

What I would say, and I think what we've observed, is that the information that HCPs are getting and the way that we communicate to them has not necessarily changed in terms of substance but has fundamentally been changed in terms of the channels of which they receive it.

Arun Divakaruni:

I'll give you a couple of examples. One of the examples I think is the gold standard of medical communication has been the peer-reviewed journal, and during the pandemic we've seen a fair amount of quick publications of data that was being generated in realtime, and that has its pluses and its minuses.

Arun Divakaruni:

For one, we can get information to doctors quicker than ever. On the opposite side of that, has that information truly been vetted through the standard scientific processes? That's sort of one way where I think you've seen things operate on opposite sides of the spectrum of medical education.

Arun Divakaruni:

At the same time, we've also seen tremendous upticks in the social channels that doctors are using to receive information, so platforms like Doximity, like Figure 1, like Hippocrates. Things that deliver information in real-time to physicians are areas where we at Avant have taken a lot of interest, a lot of investment, and a lot of time in ensuring that doctors can get the information that they need in platforms that are best-suited to their unfortunately very demanding workday.

Marc Iskowitz:

I think that's a really nice way that you laid out the changes there, not in terms of substance but in terms of channels, and when was the last time you saw two doctors during a medical conference engaging in social media about a data point or a study? That phenomenon has really taken off the last couple of years obviously with the pivot from medical conference from live to digital.

Arun Divakaruni:

Sure. I would think that maybe actually over the course of the last seven to eight years we've seen a lot of physicians embrace channels like... Twitter is a great example. We'll see what happens with Twitter in the months to come, but there I think you had a much more academic and broader conversation, so you had physicians who were at a conference who were live-Tweeting an event to try to bring it to their colleagues who may or may not have been there, and then you have an academic conversation around a particular data point, what a study mean, what its particular impact is.

Arun Divakaruni:

That was a kind of nice-to-have. Right? It supplemented the overall conversation that was happening around science and medicine. I think what COVID did and the impact of COVID to medical practice made these channels a must-have, and it allowed them to give information in real-time to people who are treating similar conditions to their own.

Arun Divakaruni:

That just goes very well beyond infectious disease and I think actually the acute treatment of COVID-19 and its related symptoms, but you had folks who were avoiding medical care because they didn't want to be in the hospital, and I can't blame them.

Arun Divakaruni:

Myself included, and I'm sure you, Marc. If we think back 18 months ago, the hospital was kind of a scary place to be. Why would you want to go to an institution where you know that there are people who are sick, and then you may not only contract it for yourself but bring it home for your family, so I think what we'll see is the impacts of this not only in the few months to come but manifest in many different ways from avoiding mammograms and other cancer screenings to perhaps putting or delaying a visit to check on a certain chronic condition like Crohn's, or another gastrointestinal disease, or something like that.

Arun Divakaruni:

I think what we'll see is that not only has care been fundamentally changed for the last and the administration of care for the next 10 years or so, but then also the information of how doctors are dealing with those changes and then how they're sharing how new medicines, and new procedures, and new approaches can perhaps even correct or account for those changes in the way that we consume healthcare in the United States.

Marc Iskowitz:

Certainly. Yeah. You mentioned earlier about peer-reviewed journals, and we had heard in the last several years about the oftentimes slowness of medical information as it percolates through the traditional academic and peer-reviewed channels, and the last couple years we've sort of had the emergence of medRxiv and these prior-to-peer-reviewed releases of papers. We just reported on one last week about the growth of telemedicine in certain disadvantaged communities.

Arun Divakaruni:

Absolutely.

Marc Iskowitz:

You have to read that with a caveat, but as you said information is getting to docs more quickly than ever, so what, if anything... I think it's a good segue to the next question. What, if anything, remains the same today as it was before COVID regarding HCP engagement?

Arun Divakaruni:

For one, I think the most important thing, at least in my opinion, is authenticity and credibility as it relates to what you're trying to say. That can't change. That has to be paramount because it's quintessential to patient care.

Arun Divakaruni:

Unfortunately, doctors don't have the time to vet by themselves every single piece of information that comes across their way just in the same way that we consume news and other media. We have to have trusted sources. We have to have credible places that we can draw information from, so I think that will remain a constant.

Arun Divakaruni:

To your point, it is kind of ironic in the sense that science is moving so quickly. Now, think about even just the development of the COVID vaccine and what's happening in a number of different areas like oncology and virology, rare diseases. The science is moving very, very fast, and I think it's up to us as medical educators, and communicators, and marketers to be able to develop channels that are moving just as fast as the science to give doctors that credible information because if we don't, then time becomes the limiting reagent.

Arun Divakaruni:

Time becomes the factor that prevents a patient from receiving the medicine that they need, the care that they need, the procedure that they need to ultimately save or improve the quality of their life, and so it is a difficult challenge for folks in our position, in your position, as industry observers to push us and the entire industry to be able to deliver authenticity and credibility in new and different ways.

Arun Divakaruni:

I would also say to our current clients and our perspective clients it's an area where I think being progressive is a smart risk to take because if we don't, then there is a human cost to it.

Marc Iskowitz:

Sure. Whenever we've seen in the past where the flow of critical medical education information is interrupted, then lives are certainly at stake, and that was certainly said in March of 2020 that we need to find a way to turn that funnel back on, and I think that's why.

Arun Divakaruni:

Sure.

Marc Iskowitz:

We saw the stage left to digital, but the authenticity and the credibility of what you're trying to say is certainly... That resonates. That remains the same today versus two years ago versus 10 or 50 years ago, and that-

Arun Divakaruni:

I would say, Marc, not to interrupt, but what I would also say is that even before the advent of all of these channels, the industry when it's face with really important advances, and I'm thinking about the development of medicines against HER2-positive breast cancer, that's an area where things have just flipped very quickly. The development of HER2-targeted medicines for metastatic breast cancer have saved tens of thousands of lives over the years. To cut the risk of cancer-related death in that particular disease by 10,000 people a year has over the course of the lifetime of these medicines have saved hundreds of thousands of lives.

Arun Divakaruni:

If we could do that as an industry before the advent of Twitter, and Sermo, and Doximity, and all of this sort of stuff, why can't we do it now? We should be doing more of that now, and I think that's an area where we at Avant are very focused on how we can make sure that we're delivering authentic and credible information because we were able to do it before when we had rotary phones and journals. Why can't we do it now when we have smart phones and lightening-speed internet? You know? It's not outside of our capability and our will to do so.

Marc Iskowitz:

Sure. Sure. You as the agency and we as marketers have to come up with marketing channels, as you put it, that move at the same speed as the rest of medicine is moving today, and it's moving faster, so let's talk about the approach that you take to engaging HCPs these days.

Arun Divakaruni:

Sure.

Marc Iskowitz:

You mentioned that we're kind of past. We're kind of in the HCP professional social media 2.0. You know? We've seen the emergence of Sermo and Doximity, certainly healthcare Twitter, physician Twitter, whatever you want to call it, the big influencers that are there, so given all of that and the way doctors' information mix has changed and their sources of clinical information are in flux, what are the critical aspects of today's approach to HCP engagement that you leverage as you build a new brand strategy?

Arun Divakaruni:

Sure. That's a good question. It's a complicated question. I'm going to try to be brief. If I'm not, please cut me off because it's a big pill to sort of swallow, but I do think that if we look back to maybe the traditional archetypes that have been taught in business schools for generations around developing awareness, and ultimate trial, and use of a particular product whether or not it's a hamburger to gene therapy for a rare disease, the fundamentals of the principles remain, at least in my mind, very similar.

Arun Divakaruni:

What we have to do is a better job of matching the type of message, the desired action, to the channel that people are consuming it in.

Arun Divakaruni:

A good example is direct-to-consumer advertising for medicines. There's two countries in the world that allow it, here in the United States and then I believe New Zealand, and somebody can correct me if I'm wrong, arundivakaruni@avanthc.com. Please send mean correction, but I do think that's sort of the area where we can create a fun, tongue-in-cheek type of catchy tunes that will allow people to understand that there is a new product on the market, one that addresses a particular need, what the benefits are, what generally the risks are, and that will allow someone to understand that, "Okay. Maybe there's something new I should consider."

Arun Divakaruni:

Now, once you start to get to the point of is this medicine right for me, then there's a bunch of different channels where I think things become a little bit more complicated. How does a doctor have a conversation with another physician who is either part of the clinical trial who has used this medicine before to have a deep, and engaging, and authentic conversation about what type of patient is the right one for this particular medicine?

Arun Divakaruni:

Likewise, as you get into point-of-care, are there ways that we're making sure that doctors have that information at their fingertips, at their iPads, at their computers where they can really sort of look at their patient's particular medical history, match it up against what the risk/benefit profile of a particular drug could be, and see if it's a good fit, and then ultimately it gets administered in the pharmacy, are there any other things that the patient didn't even mention?

Arun Divakaruni:

Maybe they're on a particular blood pressure medicine, or a cholesterol medicine, or something else where there could be a drug-drug interaction, and how does that information get to the pharmacist to sort of say either, "Hey. This thing is the right thing," or, "I'm going to raise a red flag"?

Arun Divakaruni:

So as we sort of walk down the canonical, I guess, marketing sort of funnel, are we being the providers of information to give healthcare professionals the right type of information at the right time in order to ultimately serve the patient?

Arun Divakaruni:

Moreover, when you look at all of these sort of different areas of how we're talking to physicians, and we're talking to healthcare professionals, are we really telling the story of what a medicine can really do and how they can change a patient's life?

Arun Divakaruni:

We are, and rightfully, a heavily regulated industry, and what are the ways that we're exploring direct-to-consumer marketing, promotional medical education, continuing medical education, and then even areas like in medical affairs where we have true peer-to-peer interaction between doctors at a company and doctors who are prescribing products at the point of patient care so they get a 360 approach to what they're doing for the people that they're treating.

Arun Divakaruni:

I think ultimately if we can anchor our ethos on making sure that patients have access not only in terms of affordability but access in terms to the availability of a new medicine for something that can help particularly serious and life-threatening diseases, then we as an industry will be in a good spot.

Marc Iskowitz:

Great. I'm going to butt in here for a second because you said a 360 approach.

Arun Divakaruni:

Sure.

Marc Iskowitz:

I think that really resonates today, especially with given everything you've said about how doctors' information diet is morphing of late, and when you marry that up with the need for authenticity and credibility of the message, it really is... No one channel is really going to be the answer. It's more of a 360 approach, ecosystem approach.

Marc Iskowitz:

Let's talk more about how you preserve that authenticity. There's a lot of... We haven't mentioned this yet, paid sponsors.

Arun Divakaruni:

Yep.

Marc Iskowitz:

We've seen the rise of the digital opinion leader in the last couple of years, but you have digital influences, and it's not always possible for the clinician, the busy clinician, to kind of discern. Okay. Who's paid? Who's not paid? How do you preserve the authenticity of pharma brand voices to better resonate with your target audience amidst this heady mix of paid sponsors and digital influencers?

Arun Divakaruni:

That's a really great question, and I think the answer may be somewhat unsatisfying because I don't think that there is a magic formula to it.

Arun Divakaruni:

I think what we can do is learn from other people who are doing very similar things to us but maybe doing them in very different spaces, and so I think a good example is what's happening with even... This sounds crazy, but quick-service restaurants. Right?

Arun Divakaruni:

You have advertising campaigns that may raise the awareness of a certain brand. I'm loving it kind of pops to mind because there's a couple of them down the street from my house, but you also have influencers whether or not they may be globally recognized Korean pop groups, to hip-hop artists, to sort of other folks who are driving real engagement with the brand.

Arun Divakaruni:

Irrespective of whether or not they're receiving some level of compensation to it, I do think that the message that they're trying to get across is one that's not only authentic to who they are but also authentic to the products that the company is creating.

Arun Divakaruni:

Not that I want to be talking about hamburgers, or I think I get to say nuggets, but as it relates to really important medicines, whether or not they're gene therapies or they're the next generation of targeted cancer medicines, it's important that we follow the standards that we've always sort of followed where you go a meeting like American Society of Clinical Oncology.

Arun Divakaruni:

The first slide that any presenter will put up is their disclosure slide, and so it's important that people understand where there may be a potential conflict of interest, but ultimately the one advantage that we have over maybe some of the products and the things that I've talked about before is that it's based in science and should be based in peer-reviewed science and based on clinical experience.

Arun Divakaruni:

In that sort of way, I think that when we figure out how to work with other individuals who may be evangelists or even detractors of a particular medicine or product that we have a conversation that's based in fact and that's based in at least the best evidence that we have today, and luckily for us in a world where perhaps truth gets questioned a little bit more than it should we have data and information that can help support one opinion or another, and oftentimes I think as the science moves quickly we may not have a 100% accurate, factual answer, but what we can have is an informed and reasoned conversation that ultimately is focused on what's best for the patient.

Marc Iskowitz:

Okay. Yeah. I mean, that is reassuring. It's no rocket science-type change in how we're going to maintain that authenticity. It's, as you said, falling back on the making sure the conversations we're having are based as much as we can on peer-reviewed science and clinical experience whether you're talking to an evangelist or a detractor. That makes sense.

Arun Divakaruni:

Sure. And rocket science isn't a guarantee either. If you've seen Apollo 13, there are plenty of people who had different opinions of how to bring that ship back to earth, and eventually we got it right but everybody was focused on the same goal.

Marc Iskowitz:

Sure. Sure. Yeah. We can all agree on that.

Arun Divakaruni:

But all of those conversations were based in at least some interpretation of generally agreed upon facts.

Marc Iskowitz:

Mm-hmm (affirmative). Now, we know that the clinician is super-busy today as ever, and a lot of them have voiced their opinions. Certainly, the studies that we've seen have shown for getting information on-demand at a time that's convenient for them. How do you help HCPs get the information they need to better treat their patients when they're under such time constraints?

Arun Divakaruni:

You put it on-demand. You just answered your own question. Right? Think about the way that we consume information or entertainment, and the one thing that I think is really important is that growing up in a family of physicians with a lot of friends that are physicians, they're not different than you or I. Right?

Arun Divakaruni:

When is the last time there was appointment television? Perhaps March Madness. Perhaps something that's live. Everything else is consumed on-demand from Ozark, to Game of Thrones, to all of these sort of things. Doctors watch them just as much as we do, and likewise when I want to learn about something new and different, I try to find those channels which work with my schedule.

Arun Divakaruni:

What we try to do here at Avant, and I think what we've been very actually successful in doing. I wouldn't say, "We try." I think we're doing a pretty good job of it is presenting the information that can be didactic in an on-demand sort of way. Right?

Arun Divakaruni:

You'll watch a presentation about a new medicine and a new drug. Now, that opens up a myriad of different questions. Then, what can I do to take that information and the presenter of that information and connect it to the people that are using it?

Arun Divakaruni:

Now, it may sound a bit reductionist, but that's the same thing that's happening in entertainment and other types of information right now. You have a show. People watch the show, and then you typically have something that's online where you can live-Tweet with the actors, or talk, or ask a particular question and gain some information about that.

Arun Divakaruni:

I don't think that that's fundamentally different for the way that physicians and other healthcare professionals are consuming information right now, so what our job is as healthcare educators and marketers is to help our clients create those ecosystems for them to do that and then also let other healthcare professionals know that they exist. Right?

Arun Divakaruni:

There isn't necessarily outside of maybe some of the big platforms that we've mentioned before the giant Netflixes, or HBO Maxes, or those sort of things as it relates to these particular subjects. However, that shouldn't prevent us from creating these micro-communities that are tailored to the particular patient groups that doctors are specialized in.

Marc Iskowitz:

Sure. Yeah. We've done a couple of stories, podcasts, etc., on that on-demand model, and they've been very popular, so I think a lot of people are thinking about that now perhaps more seriously than they have in the past.

Marc Iskowitz:

I mean, it's, again, nothing new, per se, but the last couple years kind of sprayed some accelerant on that trend.

Arun Divakaruni:

Sure. And it's not like everybody's going to stop what they're doing and listen to Marc and Arun have a chat. They're going to listen to it on their own time when they feel like that's something that they're interested in listening to.

Marc Iskowitz:

Absolutely. Right. Definitely. One last question, Arun, and I'll let you go. Break out your crystal ball for a second and tell me. What does the future look like for some of the traditional HCP channels that we've been talking about, medical journals, pharma conferences? How do we maintain their relevance in a world that's changing and where you see new kind of permutations of marketing channels popping up all the time?

Arun Divakaruni:

If I was really, really good at that I would probably be an investment banker, but what I can say is that from what I've seen from and working very closely hand-in-hand with people who are consuming that information, people who are providing that information, is short, medium, and longterm changes.

Arun Divakaruni:

I think the short-term thing that we will sort of see very quickly, knock on wood hoping that case counts stay low, is a very quick return to the socialization aspect of medicine, particularly as it relates to conferences, as it relates to advisory boards, peer-to-peer education.

Arun Divakaruni:

From now to the next 18 to 24 months, we're going to see a return to the Socratic method of education in medicine. That's how it's been developed and how it's been taught for thousands of years after which depending on how market circumstances manifest, I think what we're going to see is a lot of hybrid type of education. Right?

Arun Divakaruni:

You'll have people who want to be part of something socially. There will be folks that will be there in-person. Let's say if we take together for example a peer-to-peer program, and it's incumbent upon us as agencies to be able to create seamless experiences that not only integrate people who are sitting in our offices like ourselves, but also how do we make that work with people who are sitting in a room together?

Arun Divakaruni:

That's a difficult thing, and I think we're all sort of figuring that out. I'd say at Avant we're having a lot of success with different types of platforms that we're using, different types of formats, and moderates, and all of that stuff, and it's going pretty well.

Arun Divakaruni:

Then, ultimately I think in the longterm that's when the crystal ball becomes a little bit fuzzy because looking out five to six years in the future, nobody would have predicted where we would be today five years from now, but what I can say is that the constant that we talked about before for the need for authentic and credible information at a time when doctors and HCPs have the time to be able to access it is still going to be there.

Arun Divakaruni:

The channels may change. I don't think that we'll see a lot of maybe robust peer-reviewed discussion on TikTok, but we may see something that's very similar to that like a video-based short type of bite-size sort of channel, so that's the job of I think the agency, and good agencies, their job is to help companies meet the demand of their consumers.

Arun Divakaruni:

That's what we at Avant are trying to do, and I think we're being very successful in doing that is looking to see. We may not be able to predict the longterm future, but we're doing a really good job of looking around the corner and helping our clients be there at a time when their consumers, and their clients, and their customers need them to be.

Arun Divakaruni:

That may be an unsatisfactory answer to your question, Marc, but I do think that in the short and medium-term we'll see a bit of a return to where the world used to be and then in the future have to quickly pivot to be where our consumers will want to be, meaning that how can I not only make the demands of my professional life work with demands of my own personal and clinical life?

Marc Iskowitz:

Sure. Sure. Well, to that end as you evolve the HCP engagement model for the evolving commercial model, I hope we can do this again. This has been a great conversation. Thanks so much, Arun.

Arun Divakaruni:

And thank you so much for having me. It's a real honor to be part of the MM&M 100. It's something that I think every agency is is that's a part of it. It's proud to wear as a badge of honor.

Marc Iskowitz:

Thank you. Appreciate that.