A strategic overhaul of medical affairs can help pharma companies win in an era of Big Data medicine. The most competitive pharma companies in the coming decade will be masters of data and digital technologies. They will generate and analyze vast volumes of real-world data and excel at communicating scientific evidence. Above all, they will help physicians navigate in a far more complex healthcare universe.That profound shift is already under way.
Why have so few pharma companies started down this path?
Most remain focused on products instead of outcomes and emphasize marketing over medical education. Not surprisingly, they are ill equipped to address these new imperatives, much less seize the opportunities in medical education and evidence generation.
Research by medical education consultant Joseph S. Ross, PhD, and medical affairs management consulting firm The Impact Group shows that medical affairs roles in medical schools have been declining for decades. A prime target of Big Pharma’s marketing onslaught in the 1980s, medical schools are now dominated by teaching hospitals and their medical centers, which increasingly take a hard-line approach to medical education funding. And while medical associations continue to spend money on medical education programs at universities and write guidelines for physicians about what medicines should be prescribed (and which ones avoided), they too are under tight financial pressure due to diminishing membership dues from practicing doctors.
The result is that fewer doctors today are engaged in medical education than ever before – a trend that will accelerate as new MD-PhD medical school graduates take up residencies in the medical center universe, far from medical schools. Medical education budgets that were once funneled through medical affairs are now directed within medical centers and teaching hospitals – where they can be used for a variety of purposes unrelated to medical education.
As medical affairs becomes marginalized by its parent companies, traditional medical communications functions are also being usurped by digital natives outside the pharma industry who tap into this vast reservoir of real-world data. These new players run clinics and provide smart phone apps with coaching on how to live healthfully. Even newer entrants like 23andMe generate and analyze genetic data of individuals across generations (with or without their consent). All these entrants gain knowledge about which drugs work best for specific patients and medical conditions.
Yet traditional medical affairs executives, with a mandate only to promote their parent company’s products, are unable or unwilling to engage in evidence generation and medical education on a mass scale. Instead, they focus on medical information programs for doctors about individual drugs that they know will be out of date soon (as new data supersede medical knowledge).
Given the shrinking medical school pipeline and the commercialization pressures on medical schools and hospitals, what is medical affairs’ future? The answer lies in reinventing its purpose by expanding into medical education and changing how doctor-company relationships work. Medical education budgets that were once funneled through medical affairs can now be used as seed money for joint ventures between pharma companies and teaching hospitals – creating centers of medical excellence based on medical education and evidence generation.
The medical affairs function aspires to become a medical education resource for physicians, medical school faculty, medical associations, medical journals and research centers. Its ultimate goal is to help doctors improve the lives of their patients by providing customized medical knowledge. Medical officers can wear multiple hats in this new world – medical educator, medical journal author, digital coach for patients and presenter at medical conferences. The boundaries between services traditionally provided by medical affairs have been disappearing as individual medical officers create more opportunities for their own career development while serving a larger mission of helping clinicians improve patient care.
Medical Affairs Value
Transforming medical affairs to medical value creation will require a few cultural shifts: medical affairs medical officers must gain expertise in medical education; medical affairs leaders must shift their focus from promoting products to creating new medical knowledge; medical affairs budgets should be mostly used for medical education initiatives and research projects; and internal incentives at medical affairs operations must discourage performance on sales targets alone. At the same time, pharma companies can benefit from a more nimble and agile internal medical team that serves multiple functions.
Doctors are now overwhelmed with information ranging from scientific journals to drug ads disguised as medical journal articles, but they have limited tools to wade through this vast body of knowledge. In addition, doctors today face increasing pressure from all sides to practice evidence-based medicine and avoid any activities that would cast doubt on their medical judgment. As medical professionals, doctors have been trained to be skeptical of medical claims, and the medical literature has become so complex that even specialists cannot keep track of all published medical data.
Medical education that is customized to individual physicians can ease this burden substantially. Medical affairs executives must think more broadly about how to achieve efficiencies in medical education and information delivery by partnering with medical schools and big pharma companies’ own scientists (who are already generating mountains of research data). If these pharmaceutical-school collaborations produce medical evidence instead of products, they will benefit patients by spurring medical innovation—perhaps even in areas beyond drug development where some educational outcomes could be a leap forward from existing scientific knowledge.
In short, what at first seems like a medical affairs function that is being stripped of its medical and marketing value may, in fact, be re-conceptualized as medical education that is customized to individual physicians.
The Science Behind Medical Education
Big Pharma’s medical officers are mostly from academia, so the concept behind medical education comes naturally to this group. What has been missing has been an understanding of how medical knowledge can be communicated using new digital technologies with advanced data analytics. The massive volume of medical literature and other scientific evidence now available in electronic format invites novel medical research questions beyond what big pharma knows today—including such areas as neuroscience, aging medicine, immunology and tobacco-addiction treatments.
Science is rapidly evolving by inviting everyone with relevant data – patients, families and medical officers – to participate in medical research. The medical community must accept that medical knowledge is never finalized but always evolving depending on the latest scientific discoveries and medical evidence from all stakeholders involved in patient care.
Big Pharma would be well advised to support medical research using clinical protocols embedded with sensors or wearable medical devices. New medical applications are developed every day, but they often remain unimplemented because of poor reimbursement models and lack of physician buy-in. A more fruitful model would be a new framework for payers, physicians and patients working together as stakeholders in medical research studies involving these emerging technologies. Big Pharma should lead this effort by creating big data analytics tools that would help merge patients’ health records with their unique lifestyle traits (such as smoking habits) and medical histories.
Medical Affairs as a Service
By embracing medical innovation, medical affairs executives could take their companies’ traditional medical education role to a higher level. Medical education would no longer focus only on helping doctors use drugs more effectively but would include ancillary medical services ranging from medical devices to consumer products and lifestyle changes for broad public health benefits. The new medical affairs function could become part of what I call “medical affairs as a service.”
The medical affairs team dedicated solely to drug development could be given broader responsibilities that involve medical innovations in areas such as public health or big data analytics tools that help physicians make important healthcare decisions … the list goes on and on. There are so many ways in which major medical advances can reshape the practice
How can pharma companies make this vision work?
They should begin with an honest look at what they are currently doing across medical information, medical science liaison, medical education and medical publications. Then they can map out a new medical affairs strategy that puts medical education at its core. The medical affairs team must then be empowered to work with medical schools as equal partners in evidence generation, rather than being viewed as the parent company’s big brother dictating what information is taught to medical students and residents.
Innovative pharma companies will recognize the benefits of this joint venture approach – not just for medical officer career development but also for better serving physicians, patients and society as a whole.
The biggest risk is that medical affairs teams inside pharmaceutical companies assume their internal structure is sacrosanct while failing to reinvent themselves as they face these disruptive forces outside the industry. Unless non-traditional competitors like medical journals and medical schools are brought into the medical affairs team, they may be left behind.
In this new era of Big Data medicine, leading pharma companies will generate vast amounts of medical knowledge directly from real-world evidence – which has become a commodity (for better or worse) in this information age.
