Is pure play pharma's new pharmakon?

The shift in commercial teams has been happening for some time. This is not new news. I have felt it many times over, like many of us who have worked in the industry for years.

What we see in many cases is that field teams have become smaller. In others they have been removed entirely. The expectation to do more with less has never been greater. The elephant in the room is not just a metaphor; it is something being felt daily, especially within commercial teams. That elephant, the one that built market access, shaped prescribing behaviour, and carried entire launch plans on its back, is now being asked to be something it was never designed to be. Fast. Agile. Real-time.

Then, pure play entered the room. Promising scale, efficiency, and reach beyond anything the field force could deliver. But, like the pied piper, the promise was real - it was the destination that needed more thought.

The glass window effect

That destination, for many, has been reach without relationship. Volume without resonance. A healthcare professional who receives content they did not ask for, from a company they once knew personally, through a channel that cannot hear them back.

What that feels like, from both sides of the exchange, is what I have coined as the "glass window effect". You can see in, you can observe, and you can measure the distance between yourself and the clinical community on the other side. However, you cannot touch, feel, or interact with anything real. The glass gives the illusion of proximity. It is not the same thing as contact.

Pure play engagement, as currently designed, is optimised for the clinician's action. It is not designed for their participation. The content arrives targeted to a clinical need, because nobody asked. No infrastructure exists to ask. The healthcare professional simply receives it or does not. In many cases, it is the latter. What was once a valuable exchange, now nobody is sure either party is better off, let alone the patient.

And yet, the very thing pure play cannot deliver is the thing it depends on. The genuine, two-way, fairly valued participation that provided the building blocks of the brand equity, the clinical understanding, and the relationships that every pure play programme is now trying to leverage. The asset being spent was created by the model being replaced.

The relationship that was once a conversation has been packaged into an automation sequence. Brand equity built over decades does not transfer automatically into pure play. It is being spent quietly, invisibly — every time a healthcare professional closes another email from a company they once trusted.

The trajectory of that, without intervention, I believe is a closed digital door. And trust, once lost at scale, is not recovered with a better subject line.

The wall was not built by one side, though. Doctors, understandably, asked to be seen less. Pharma, understandably, welcomed the cost saving. Two rational decisions, made independently, that created something neither side intended - an invisible barrier that now self-perpetuates. Access becomes harder, so, engagement retreats further into digital. Digital fails to replicate the relationship, so, it erodes trust further. The cycle continues, and it is benefitting no one.

And that is precisely why no single company can fix it. The wall was not built by one hand. It will also not come down through one company's platform, however well designed or well intentioned.

A blueprint for the future

Some years ago I found myself in a room that I believe was the blueprint for the future. A clinical community built organically, where clinicians had the voice they needed to discuss clinically relevant topics, the ability to collaborate independently and entirely on their terms. The healthcare professionals on stage, those who had never appeared on a standard advisory board list, were saying genuinely important things. They had a voice and a platform to share. Industry partners were also in the room, having kindly sponsored the meeting as a third party. There was a company that wanted to be present, not to present, not to promote, simply to listen and to be in proximity to real clinical thinking.

I suggested a modest contribution to the room. They agreed immediately. That contribution went to the clinicians sharing their time and expertise. What struck me was not the transaction, it was how naturally the conditions for trust had assembled themselves. Everyone knew who was in the room. The content belonged to the clinicians. The company's presence was transparent and its contribution acknowledged. The exchange was equal and visible.

What stayed with me was not the event itself. It was what made it possible. The clinicians had the knowledge and the willingness, but not the time to build the space themselves. Industry had the interest, but not the neutrality to own it. What made it work was the infrastructure in the middle. Independent. Neutral. Holding the conditions for trust without belonging to either side.

That is not a model. It is a blueprint.

I believe that blueprint has four conditions. And importantly, none of them are new. But all of them are absent from pure play, as currently practised.

The first is verification. The room worked because everyone in it was known. A digital clinical environment requires the equivalent verified professional identity, not self-reported profiles. Without it, no clinician treats the space as genuinely professional and no company trusts the insight it generates. It also makes compliance significantly harder and, in a regulated industry, that is not a footnote. It is a foundation.

The second is relevance. The content in that room was chosen by and for the clinicians in it. Not for a commercial segment. Not for a therapy area target list. For the people present, and the clinical questions they were actually asking. Relevance at that level is not a personalisation algorithm. It is a structural commitment to putting clinical need before commercial objective. The glass window cannot tell you what matters. It can only measure what was clicked. Knowing what a clinician actually needs, not guessing from scrolls and open rates, requires infrastructure that listens, not just infrastructure that sends.

The third is transparency of exchange. Every contribution acknowledged. Every presence documented. Every recognition made at fair market value and available for audit. Not because compliance requires it, but because trust requires it. The clinician who can see exactly what the exchange is worth, and knows it is recorded, feels valued, rather than extracted. This is not a new idea. It is what the elephant did naturally: the trusted presence welcomed into the room, whose value to both sides was visible and understood. The difference now is that it needs to be documented, governed, and built to scale.

The fourth is independence. The infrastructure must belong to neither side. Industry can participate openly, transparently, fairly. But the clinician must feel the space is theirs. That is not a perception problem to be managed. It is a structural condition to be built.

The four conditions are not a wish list. They are an architecture. And architecture, unlike relationships, can be built deliberately, transparently, and at scale.

Right clinician, right time, right patient

What comes next is not a replacement for the elephant. It is the room the elephant always needed, one that can exist digitally, the one where knowledge flourishes, rather than becomes stagnant with unopened emails; the one that any verified clinician can walk into, that industry can participate in fairly, sustainably, and transparently, and that belongs structurally to neither side.

Every clinician. Not just the same faces. Every contribution fairly valued. Every exchange documented and trusted by all parties. The right knowledge reaching the right clinician at the right time to help the right patient.

The cost of ambiguity is not measured in open rates. It is measured in clinical decisions made without the right information, in innovations that never reached the prescribers who needed them, and in a relationship that continues to fray while everyone optimises the next campaign.

The wall was built slowly, by both sides, for understandable reasons. The door can be built deliberately with the same care, the same rigour, and the same commitment to the relationship that the elephant always embodied.

Pure play is pharma's pharmakon. The poison and the remedy are the same substance. The infrastructure between them is the difference and that infrastructure is closer than most people think.

About the author

Rebecca James-Kinanen is the founder of THRESIO, a governed platform connecting verified clinicians and life sciences organisations. She holds a BSc in Biochemistry from University College London and has spent the last fifteen years working across the full commercial spectrum of the pharmaceutical and healthcare industry in brand, market access, medical communications, and digital strategy. With experience spanning global companies, independent consultancy, and clinical community building, she now works independently as a founder and strategist.