How doctors prefer to engage with pharma: part five
In the fifth and final part of this anonymous doctors' series, Hannah Blake interviews an oncologist (who will be referred to as Doctor E) about the information he needs regularly from pharma and his thoughts on the importance of online engagement between pharma and physicians.
(Continued from "How doctors prefer to engage with pharma: part four")
In order to get honest feedback, we shall be keeping the doctors anonymous.
Interview summary
HB: What information do you most need regularly from the pharma industry?
DE: People from various pharma companies come along to brief us about products, including the indications, research material available, previous trials conducted on the drug, and where it lies in terms of guidelines from NICE and the Cancer Drugs Fund. It's basically information about the products they have been promoting from the relevant company, and where it sits in our practice. So at various times the information may be the same, but sometimes there are updates. If it's a new drug, we want to know what guidelines have been developed on the basis of the trials nationally or internationally, and with that particular medicine, what are the side effects, safety profiles - that kind of information is relevant to us from a pharmaceutical industry person.
HB: How would you like this information to be shared with you?
DE: There are loads of ways nowadays to have information shared; face to face is the most traditional way and the way that most people like, because human touch has got lost in modern situations. I personally like that way. I have also got access to emails, post, blogs, interactive websites. But personally I would say I still prefer somebody to come and have a chat with me, sit down and have a cup of coffee with me.
HB: Conversely how do you want to be able to feedback to pharma or ask ad hoc questions?
DE: I think it is better again if you are in face to face meetings, because then you can ask questions there and then. On many occasions, the pharma rep may not be able to answer your question, so then they go back and ask their medical liaison officer, who may then come back to us with the answer. Or there may be new information which the rep may not be able to provide himself, but somebody else from the company will know it.
HB: How do you find engagement via online doctor communities compares with the direct engagement with pharma?
DE: Pharma engagement online is good if you are a person who is keen to get involved, predominantly out of hours. While you can do it within working hours it becomes difficult with the clinical schedule, but then having said that, you meet people face to face during your business schedule as well. But I think it is interesting when you are meeting people online, although it depends if you are just reading a blog, or if you are interacting directly with their particular site, or if you're just reading information on the website. So online could be obviously those different categories, but I think if somebody is not able to travel, say a rep where one of the drugs comes from Glasgow to us, which is a long way to travel, so I don't mind having a chat with her via email, or having a chat with her through text messages, on the phone, or sometimes on Facebook.
HB: Do you find independent online networks useful?
DE: There are very useful services on Doctors.net.uk. I use the site a lot for email purposes, and there are lots of training modules that I always encourage my colleagues to do.
I also look at the newsletter and I pick up health information that's very useful. Discussions in forums are useful as well. Whether I take part myself or not, I do generally click on those and look at what topic is being discussed. There are a few people who have put questions about oncology issues, so once or twice I have participated in them - those are very useful services.
HB: Do you think pharma should be trying to build its own online doctor communities, and if so why?
DE: If it is done by all the pharma combined it may be useful, as opposed to being done by each company, with their own website, with their own products listed. So it would be a pharma net in which our companies and their sales rep would be participating, although it may not work out because of the competing interest. Say for example in a breast cancer situation, we can give a woman three or four different products, at least in terms of the hormonal tablet, so it will become a little bit difficult for that particular website to argue which one should be given or which one should not be given. I think in that way it would be difficult to manage.
"That wouldn't have been possible had I gone only via the information from the trial, from email or internet or blogs – that only happened because of human contact."
HB: In the digital age, do you think that we still need pharma sales reps?
DE: To my mind, human contact is relevant. You can get information from anywhere nowadays, technically, I don't need to see any pharma person at all, because I can get information from journals, I can get information from Google, I can get information from any part of the world. But there are some day to day things, for example, educational activities, support at the start of arranging meetings and arranging to go to interactive conferences, you still need that human touch and human element coming along somewhere. Putting a face to a name springs to mind. So while you can certainly get information online nowadays, you may still need some clarification, and so you are then probably spending time ringing and emailing people. But that is only for people who are very enthusiastic about a certain product.
With the human element, where someone comes and reminds me about a product periodically, then I am more likely to prescribe that product than say a product where I haven't been reminded about it. So from a company's point of view, yes they can put information on the web, but a periodic reminder would be helpful to promote their business, which they would not get if their information is only obtainable from a website.
I'll give you an example: there is a drug called Abraxane. Abraxane is only licensed for metastatic breast cancer as a first line treatment, and there are only clinical trials available for this indication, also. So we didn't feel as a clinician that particular indication was suitable, because it was too expensive. But we felt there was an indication for it to be used in patients whose breast cancer had been cured and who have a certain allergic reaction with a sister or cousin drug of that group called paclitaxel or Taxotere. So we went to the Cancer Drug Fund and we asked them to allow us to use that particular drug via the Cancer Drug Fund in only that subgroup that has allergic reaction to the two drugs I named, and that was approved.
That wouldn't have been possible had I gone only via the information from the trial, from email or internet or blogs - that only happened because of human contact. I can't think of a better example than that.
"Competition is getting tougher, economics are getting tight, so companies and doctors need to work more closely..."
HB: That was a really good example, thank you. Finally, if you could completely redesign the way that doctors and the pharma industry interact what would this look like?
DE: I think this interaction would be different for different people. I could look at a glass and say the glass is half full, whereas you may say the glass is half empty, but they would both be correct. This is the same with the pharma industry at this point in time. I think they have to have multi-prong approach. Competition is getting tougher, economics are getting tight, so companies and doctors need to work more closely rather than not interacting with each other, whether that's email, whether that's telephone calls, whether that's face to face relationships.
I think we need more interaction – here's another example. We have a drug where diarrhoea is a common side effect. It came along 10 years ago and we as clinicians didn't have any information to give to patients. So I designed with one of my other colleagues a copy of a patient information leaflet on which we had then put the grade of side effect, what to look for, how many stools, what colour stool, what consistency of stool, the very basic things which patients need to know about that particular drug, and then we gave that to patients at the time. And subsequently, the leaflet was published nationally and was a very good tool, which only became created through interaction between the two sides of the coin: doctors and the pharma industry. And you can pick up other examples of that, but that's one of the ones I can remember from my early days.
So my answer to your question would be: we don't need to re-jiggle the whole wheel, but I think just the sources which are available, face to face is essentially part of that, but we can utilise email, we can utilise modern technology, such as mobile phones and apps. They're all helpful, but they are not substitute of the human interaction.
About the interviewee:
Doctor E is a Consultant Medical Oncologist.
This article was coordinated by Doctors.net.uk, the UK's largest professional network of doctors. Available to UK-registered doctors in primary and secondary care, Doctors.net.uk is an effective digital channel and a trusted source of medical education, research and communication. It is used by approximately 40,000 doctors every day.
If you could completely redesign the way that doctors and the pharma industry interact what would this look like?
