Healthy Skepticism Library item: 19626

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Publication type: Electronic Source

Taylor P
Medical scientific liaisons: Sales reps in disguise?
eyeforpharma.com 2011 Sep 1
http://social.eyeforpharma.com/story/medical-scientific-liaisons-sales-reps-disguise

Full text:

Medical scientific liaisons (MSLs)—the people physicians talk to when they have scientific questions—have traditionally been separated from the marketing and commercial functions. Should the boundaries between the two functions be broken down? eyeforpharma asked some leading figures for their views …

For a number of years it has been suggested that MSL numbers are on the rise. Is that a true trend? If so, what is driving it?
Pete Sandford, executive vice president, NXLevel Solutions: Yes. More and more doctors are seeking information on their own via the Internet and other self-educational means. To supplement what they discover as well as answer questions, they use MSLs as a sounding board. In addition, clinicians expect a higher level of knowledge and clinical understanding with conversations focusing on science rather than presenting a ‘pitch’, and the MSL is the person who is required to have that dialogue.

Jane Chin, managing partner at 9Pillars and founder of the MSL Institute: Compared to 10 years ago this is probably true, but compared to five years ago, I’m not so sure, given the number of laid-off MSLs who remain unemployed, those displaced by new MSLs with doctorate degrees, and the number of MSL programmes with less than five years’ tenure. Trend drivers for this growth, or appearance of growth, could include the fantasy that MSLs could replace reps as ‘the sales force of the future’, companies ‘testing’ the MSL program concept for educational and awareness efforts during product development (Phase II, for example), and for established programs that have decided to expand their existing MSL teams as part of balancing the workload of current MSLs so that they may have more manageable territories.

Sean McCrae, senior vice president of PharmaForce International: Yes, numbers seem to be rising as companies recognize the value-added services MSLs provide and the role they can play in healthcare systems, integrated delivery networks (IDNs), physician offices etc.

How has the role of the MSL evolved over the last few years, given the changes to pharma’s operating environment and relationships with its customers and other stakeholders?
Sean McCrae: Several years ago, companies would have one MSL who would do everything. Now, a number of companies have broken out MSL into various and separate roles. One area is thought leader development—carrying out activities such as encouraging participation in advisory boards—while others include managing and supporting investigator-initiated trials and liaising with managed care organizations, for example by providing pharmacoeconomics data to support inclusion of products in formularies. This trend is helping to increase the numbers.

Jane Chin: MSLs are becoming overly-specialized. You have MSLs concentrating only on managed care or ‘education’ or research. This reminds me of the concept of multiple reps of the past where the companies attempt to get ‘additional share of voice’ with a physician by throwing three reps at the same office and have each carry one product. Of course, you can also argue that because MSLs deal with more specialized knowledge, it makes sense to have an MSL who knows about the research process and focus only on research. My opinion is that it depends. I fail to appreciate the merit of having a company deploy one team of MSL whose function is to deal with only research and another team to deal with only ‘education’ because these are so closely related that I need concrete proof to be convinced that one competent MSL is unable to carry out both tasks. Managed care for those of us in the US may be a persuasive issue, for example, to hire as MSL a person who is trained in pharmacoeconomics. But when it comes to presentation of clinical data used in making managed care decisions, again, I am biased to expect one competent MSL to fulfil this clinical presentation role. The growth of IIT/ISS (investigator-initiated trials/investigator-sponsored studies) here in the US has been an outcome of MSL engagement.

Pete Sandford: The entire life science industry is much more business driven. The era of ‘managing’ healthcare is upon us. As much as MSLs want to focus on the science, they cannot totally avoid the business side of the business.

MSL has traditionally been separate from marketing/commercial functions within pharma. Should the firewall between the two functions be broken down to improve internal collaboration/coordination?
Jane Chin: Yes and no. Yes, if company hasn’t defined boundaries and rules of engagement. No, if company has done so. Firewalls are meant to safeguard controls that are inappropriate, for example, sales controlling MSL activities for sales objectives. But today firewalls have come to mean ‘MSLs and reps shouldn’t talk to each other at all.’ These rigid firewalls speak more of a desire to eliminate risk outright and sometimes at the expense of sustainable best practice for company. One such best practice is for company personnel who interface with a common physician stakeholder to know about any prior or existing interactions originating from the company without necessarily having to know the details of those interactions.

Pete Sandford: No. I think the firewall provides a level of confidence that the MSL role is not being tainted by marketing messages and goals. At this point, I don’t believe government agencies have confidence that the function can exist within the commercial function and remain an independent scientific voice. Likewise, I imagine there is a certain amount of distrust that would exist in the medical community should the function return to the commercial arm of the organization. What should change/improve are the pathways of communication between the two functions. I think people understand the need for a close relationship between the two, but there is a certain amount of fear in letting that relationship get too close again. In other aspects of the commercial interaction with healthcare practitioners there have been great strides in defining ethical interactions as well as providing transparency into the financial aspect of that relationship. Ideally, one would want to see those same ideas applied to the commercial/MSL relationship within the company to improve the collaboration between the two units.

Sean McCrae: In the US, industry guidelines laid out by the PhRMA in 2009 plus the earlier publication of the compliance guide by the Office of Inspector General in 2008 had a significant impact on companies, and encouraged clear lines to be drawn between MSL and medical affairs teams and commercial functions. Interpretations differ though. Some companies will not allow MSLs and reps to be in a room with a doctor at the same time, and many of those that allow it have very specific policies on how the two functions can co-exist. Policy may dictate that should an off-label question come up, the rep must leave the room immediately, for example. Certain companies are more stringent than others, but we see the industry as a whole enforcing those policies.

How do you see the two functions operating side-by-side in an ideal scenario?
Jane Chin: In an ideal scenario, both the sales reps and the MSLs would have in-depth understanding of the rationale and selective pressures of the other function, such that sales reps know where MSLs object to participating in certain activities and MSLs know why sales reps behave the way they do. As a result of this understanding, each function has the discernment to operate well within the same corporation. If we don’t have this ideal, and from what I’ve seen, many organizations don’t, the next best thing is for companies to adopt their own philosophies of what their sales function and MSL function should accomplish for these companies. Upon delineation of these philosophies, company executives would now hire the right people in leadership positions who are capable of creating cultures upholding the company’s philosophy about MSLs. A component may be creation of standard operating procedures (SOPs) describing specific situations where sales and MSL functions are likely to meet and the guidelines for navigating these situations.

What is the risk that pharma companies may be tempted to instruct MSL teams out in the field to operate as ‘sales reps in disguise’?
Jane Chin: These companies will find out very quickly that a model that doesn’t work in the long run won’t work whether you have reps behind the wheel or MSLs. It hasn’t worked for sales reps for a long time, so how can pharma executives justify taking a fallible model, put new players behind it, and cross their fingers hoping for the best? We’re in the business that is dominated by the scientific method, and I’m continually mystified by how our industry’s executives seem to keep making the same decisions and hope they get a different outcome from what they had gotten before. Physicians have reduced and even eliminated access to pharma not because of ‘sales reps’ per se, but what those sales reps are instructed to do and taught to say. If you change the players and put MSLs in the same position, you will see the same result.

Pete Sandford: I find it hard to believe that in today’s climate any company would instruct their MSL’s to operate as sales reps. That said, I think there is a risk there. If the access you are getting is through the MSL team, there is temptation to deliver your marketing messages through them. In essence, that is why MSLs are no longer part of the commercial team. The key is in creating clear policy on the interaction between these two business units, and creating an environment where concerns can be raised without fear of retaliation should there appear that there is undesired crossover. I also think that most doctors will catch on pretty quickly to the MSL who is acting more like a sales rep and shut down access for that MSL.

Do the activities of the MSL function align well at present with pharma’s current market access strategies?
Jane Chin: Based on the appearance of increased visibility of the MSL function, pharma must perceive that the activities of MSLs align with market access strategies or companies would not invest in the function. I’ve always viewed MSL functions as a more long-term competitive strategy, but executives who fund programs aren’t always interested in long term, only short term, and market access is part of that myopia. In reality, do MSL programs really improve companies’ access? I don’t know. There are so many variables that confound a true ‘yes’ or ‘no’ answer. How do we know that market access couldn’t be improved by altering pharma’s approach to the sales force model, if pharma has enough patience to give their model shifts time (i.e., more than a quarter) to work? How do we know that using MSLs primarily for market access isn’t creating higher hurdles for pharma companies to win back physicians’ trust, should this tactic fail in the long term?

Pete Sandford: Yes. Pharma companies want prescribers to trust and believe in their products. MSLs allow the conversations to take place at the level that allow that trust to happen.

For more on the role of MSLs, join the sectors other key players at at Sales & Marketing Excellence Australia on September 14-15 in Sydney, 3rd Annual Market Access Canada on November 1-3 and eMarketing Canada on November 8-9, 2011 in Toronto, Key Account Management Europe on November 22 in London and Marketing Europe in November in Berlin.