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The Doctor Will See You Now
The Doctor Will See You Now Adapted from Healthcasts: Physician Voices 2016 How to get through? Ask doctors from Harvard Medical School, Mass General, Brigham and Women’s, and other major institutions.
HOW DO PHYSICIANS PERCEIVE THE HEALTHCARE INDUSTRY? Healthcasts set out to learn what the industry can do to help physicians advance patient care. The Physician Voices 2016 survey collected insights from 342 physicians across a range of specialties that included oncology, cardiology, neurology, endocrinology, and primary care. Despite the recent turmoil over drug pricing practices, physicians have a more positive view of “Big Pharma” than the general public. They still see the industry as their true partners in patient care, and they want to enhance their relationships with pharma. In fact, 30% of Healthcasts member physicians said that the information they receive from industry to inform their treatment decisions is more useful than it was five years ago. Some commented that today’s increasingly data-driven environment necessitates more Highlights from the video interviews
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of an informational approach, and that the growing number of treatment options – particularly for rare conditions – calls for an expanding body of evidencebased information, especially as mechanisms of action and dosing schedules become more complex.
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One oncologist appreciated “receiving more detail on the clinical trials related to the chemo agents now, compared to past years.” Other physicians noted that improvements in web-based technologies have increased the volume and frequency of more advanced and specific clinical trial data. Another oncologist said “The clinical trial data is now available online, whereas you used to have to wait for the meeting or the mail to get the information.” In many cases, physicians are clamoring for more interaction with pharma. “When I was training 25 years ago, we had a great relationship [with industry]. We often learned a great deal from the reps because they would bring in data that was fresh and new,” recalled Malissa Wood, MD, codirector of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School. “Because of a few bad apples, there was a heightened concern for conflicts of interest with the pharmaceutical industry, leading to a very restrictive relationship with physicians and nurses. The pendulum needs to swing in the other direction because [pharma] needs us to give them guidance by thinking about new devices, new drugs, and new patient populations, and we need them to really address the issues that are pressing with regard to some of the epidemics such as heart disease, diabetes, hypertension, and increased [incidence of] disease in young individuals.”
All of the KOLs interviewed hold high-level teaching positions at academic medical centers that have largely banned detailing by pharma sales reps. Some KOLs lament the loss of those relationships. “We miss that role in our academic centers of having the pharmaceutical team partners,” commented Matthew Powell, MD, director of the Division of Gynecologic Oncology at Washington University School of Medicine. “It’s very difficult to have any interaction with pharma anymore. There isn’t enough of it,” echoed Barbara Goff, MD, professor and director of the Gynecologic Oncology Division at the University of Washington. “We, to some extent, limit our ability to learn from pharma, but pharma has a lot to teach us. CONSTRAINTS ON PHYSICIANS’ DECISIONMAKING Many physicians feel their decision-making power has been constrained by payors and regulators. Thirty-nine percent of respondents indicated that it has become more difficult to make an independent, individualized treatment decision for their patients, compared to five years ago. When asked to specify the factors that impact their treatment decisions, 35% of respondents (including 42% of PCPs and 33% of specialists) said insurance companies exert the greatest influence because their reimbursement policies mandate use of certain therapies. “Managed care dictates what we use regardless of the message,” commented one PCP in the survey. The FDA emerged as the secondmost cited factor, due to the agency’s approval of drugs for narrow indications or specific lines of therapy. Such restrictions “make it impossible to get any more info than what is already on the package insert,” commented one oncologist. Additionally, physicians expressed frustration with communication barriers thrown up by FDA regulations. “Drug reps can only tell us what the FDA allows them to tell,” noted an endocrinologist. “Every word is vetted through the FDA,” echoed a PCP respondent, who mused that physicians “used to have some crosstalk between providers via the reps.” Compared to insurers and the FDA, pharma received less blame
for physicians’ feelings of marginalization. Only 10% of interviewed physicians cited pharma companies as a constraint for not releasing all of the clinical trial information they need to make good treatment decisions. Somewhat surprisingly, a similar percentage of physicians (10% of all respondents) mentioned direct-to-consumer (DTC) advertising for its impact on treatment decision-making.
The constraints on physicians’ treatment decision-making make it especially important for pharma to forge and maintain mutually beneficial relationships with doctors. If pharma companies position themselves as physicians’ allies in their struggles with payors and the FDA, physicians may feel more empowered to make independent decisions on behalf of their patients. WHAT PHYSICIANS NEED BEYOND THE REP VISIT The tightly regulated landscape for pharma/physician interaction does not appear to give doctors the type, volume, and depth of infor¬mation that they want and need. Even when pharma reps are allowed access to medical practices and treatment facilities, physicians are often left with unanswered questions. This is more apparent among specialists, such as oncologists, for whom the stakes are higher when making treatment decisions. • One oncologist requested information on drug prices, particularly on “how to obtain drugs when patients can’t afford [them].” • Another asked for “early clinical trial data presented at meetings
NOT part of FDA guidelines.” • An endocrinologist expressed interest in “educational material about disease state that fosters improving patients’ knowledge and improved decision-making as team participant.” • “It is helpful to know how the product is being used by other providers who are in similar practices,” commented a PCP. • One oncologist suggested, “Ad boards moderated by key opinion leaders are always the best.” WHAT DOES THIS TELL US? Pharma companies should re-think how best to provide the kind of
information physicians find most useful, and how to continue the “conversation” beyond the rep visit. For some physicians, impatience with detailing may stem from pharma companies’ focus on promoting newly approved drugs. Many physicians are interested in older therapies, which often lack field force support. See figure 1. SUPPORTING IN-PERSON HCP INTERACTION The research clearly demonstrates the need for both in-person and digital interaction for different types of education: • In-person interaction “enables a didactic dialogue and questions can be answered immediately.
While other sources are easily accessible online, in-person discussions allow for interactive infor¬mation sharing.” • Dinner speaker programs provide the opportunity to “network with colleagues and discuss their opinions, as well as those of the speaker.” • Email “is more efficient and can be read as time allows. I can read
those during non-clinical hours and not be interrupted during time devoted to patients.” • Online information can be accessed “at my convenience – not in the middle of a busy office day.” The survey results also revealed some interesting findings in terms of preferences for non-digital access to information, as illustrated in Figure 1. Specialists were more likely than PCPs to say they look
Figure 2
for more in-depth information as provided through medical journals and KOLs. On the other hand, PCPs, especially those under 44 years of age, tend to seek input from colleagues within their practice/local area for information, whereas older PCPs and specialists (i.e., over 45) rely more on sales reps and MSLs than their younger colleagues. See figure 2. There appears to be no substitute for live presentations by KOLs on
specific topics as a trusted source of information. Two-thirds (67%) of the physicians cited live KOL speaking engagements as the most useful vehicle for learning about new treatment approaches. However, live events have their drawbacks, foremost of which are time and money. Many physicians are unable to attend live events, and thus may represent missed educational oppor¬tunities for pharma. Indeed, “A lot of physicians now are relying on media and the internet to obtain information from remote sources because a lot of them can’t afford to come to meetings,” noted Dr. Toth. Jeffrey Gudin, MD, director of Pain and Palliative Care at Englewood Hospital and Medical Center in Englewood, NJ., said “Physicians [today] are able to educate themselves on their own time at home. To have a three- to four-minute snippet to see what is going on in the world of medicine is just remarkable.” For many physicians, on-demand access to web-based technologies complements their need for interpersonal contact. The emergence of new technologies has actually made it easier for physicians to get the information they need. In fact, 50% said it is easier or much easier to obtain information to inform treatment decisions today, compared to five years ago. When asked how they like to get information to make treatment decisions, on average, both PCPs and specialists expressed a preference for digital means of communication. “The world is changing,” observed Sekar Kathiresan, MD, director of
preventive cardiology at Massachusetts General Hospital and Associate Member of the Broad Institute’s Program in Medical and Population Genetics at Harvard Medical School. “There are really important creative ways [pharma] can communicate with the physician audience using the current technology.” When asked about specific ways to learn about treatment approaches through innovative digital means, physicians cited their top 5 preferred vehicles: 1 Short online surveys to test their knowledge of different therapies, clinical data or patient cases 2 Short online presentations or outlines of clinical data that can be accessed at any time 3 An online platform to look up specific information on drugs 4 Online topical videos of KOLs that can be watched any time 5 Printed Q&A materials from a KOL AN OPEN, TRANSPARENT, AND CONSTRUCTIVE DIALOGUE “The best interactions are open, they’re transparent, they’re driven by what patients need, actually brokered through doctors’ knowledge, and [there is] no harm if industry is willing to support that,” stated Peter Goadsby, MD, PhD, DSc, professor of neurology at Kings College, London, and director of the Headache Center at the University of California, San Francisco. In his video interview, Dr. Goadsby emphasized the importance of including patients in these discussions: “Bring everyone together and you can use everyone’s expertise and resources to make things bigger. [When] everyone is at the table, everyone benefits.”
“Physicians are asking questions about mechanism and how and why. Maybe we should be asking, ‘what’s better for my patient?’ and rethinking the prescriptive process,” commented Paul Ridker, MD, senior physician at Brigham and Women’s Hospital and Eugene Braunwald Professor of Medicine and Director of the Center for Cardiovascular Disease Prevention at Harvard Medical School. “Companies need to figure out a way to say, ‘but the patient is living longer,’ and remind us that’s our core issue.” Finally, the importance of a constructive dialogue cannot be overemphasized. Indeed, public health and patient well-being depend upon a free flow of incisive information between physicians and pharma. In her video interview, Dr. Wood summed up this vital issue quite succinctly: “It needs to be a two-way street, with better communication from us to the industry and from industry back,” concluded Dr. Wood. “If we can create that bidirectional flow of information in a non-conflicted way, we’ll really be able to move medicine forward.” • About Healthcasts Healthcasts is the leading educational resource for physicians with an exclusive, verified network of practicing members that spans over 30 clinical specialty areas. Since its inception in 2001, Healthcasts has been leveraging research and member feedback to provide relevant, personalized educational content from more than 50 medical conferences, insights from Key Opinion Leaders and CME programming through partnerships with leading educational institutions. Healthcasts programming is available digitally, ondemand on all devices for an optimized, crosschannel experience.
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