KOL perspectives: Professor Peter Fitzgerald

Rebecca Aris interviews Professor Peter Fitzgerald

Stanford University School of Medicine

Professor Peter Fitzgerald of Stanford University School of Medicine shares his thoughts on how the pharmaceutical industry and KOLs can work together successfully.

In this series we seek to hear KOL’s perspectives on how they think they could best collaborate with the pharma industry.

In this interview we speak with Professor Fitzgerald of the Stanford University School of Medicine. Prior to being trained medically Peter was an engineer. He later trained in medicine, and in interventional cardiology. He now combines these disciplines at Stanford where he is a professor of medicine.

Professor Fitzgerald speaks with pharmaphorum around the changing cardiovascular technology landscape and how the relationship between pharma and the KOL is evolving.

Interview summary

RA: How do you see the cardiovascular technology landscape changing both locally and globally as pharma and device companies look to be more innovative in the future?

PF: There’s no doubt that this landscape is changing. Having been involved in it since the late 80s, we watched it mature in the 90s, get much more complex in the early 2000s.

Now in cardiovascular chronic diseases we have to be very focused on being cost effective. It’s not just about coming up with a product that might be contributing to a series of products, or contributing to a specific need such as an ulcer, but we also have to make sure that we take care of the underlying principle for generating that ulcer.

Globally, the landscape has definitely become more enhanced, but also more complex. Some of the devices that may work in California don’t work well in Mumbai India. Different regions require a different focus of what technology is to satisfy those particular areas. It’s fascinating, and it has generated phenomenal innovation, but the innovation is not focal anymore, it’s definitely global.

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“Some of the devices that may work in California don’t work well in Mumbai.”

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RA: What challenges do healthcare practitioners face as they embrace new technologies in medicine?

PF: The technology has to address the health consequences in a given region. Take the US, for example, what is it that governs a good technology?

One of the important issues for hospitals today is random blood transfusions. Blood transfusions are expensive, they come with in-hospital sequelae, and they often lengthen the hospital stay. So we want to reduce them.

Another issue is avoiding infections as a second category, hospital-acquired infections increase the price of the hospital stay, and the stay is often extended. Anything that we can do to decrease that infection base while in the hospital is going to be very important.

A third important issue is rehospitalisation. Between 20 and 25% of our Medicare patients in the United States are re-hospitalised 30 days after they’re discharged. There are a whole series of innovations that can keep that number down.

So those three issues spark areas of innovation.

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“Between 20 and 25% of our Medicare patients in the United States are re-hospitalised 30 days after they’re discharged.”

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RA: How can industry and KOLs guide young stakeholders to understand the complex path from concept to commercialisation?

PF: Well you have to be like me – you have to be old, you have to have experienced and have made a lot of mistakes. Having been involved in 50–75 of these concepts over the last 20 years, trying to bring them into the clinic and ultimately commercialisation, there are so many ways to make a mistake, and you don’t really know that until you actually have made them.

So some of the young entrepreneurials, the 30 year old who’s had a cell phone in his or her hand for the last six to seven years thinks differently about information, and has a hand / eye co-ordination that’s far more advanced than a 50 year old that wasn’t raised in that particular time period. Those young folks are the next innovators, they’re the people that are going to invent.

However, they need the folks with some grey hair that have made the mistakes to help them guide this complex navigation. It is one of the things that I get the luxury of participating in, enjoying hearing these wonderfully smart ideas from the young, but helping them navigate so that it can get into the clinic effectively from a clinical standpoint, and also a cost-effective standpoint. That really does require a number of people that have had that experience to shuffle that process along.

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“I don’t think the KOLs are as important as they used to be.”

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RA: Finally what do you think the future of the KOL / industry relationship looks like?

PF: I don’t think the KOLs are as important as they used to be. I am not the customer anymore. Those decisions of which device to use are now being made by group purchasing organisations, by the CFOs and the CEOs in hospitals and insurance companies.

Those KOLs should actually not be largely physicians anymore. The process should also embrace the folks who are making some of those decisions that allow that device from the clinic to commercialisation.

In a KOL meeting I sit next to a CFO of a hospital, and next to one of the insurers because it takes that larger appreciation of how the system works to comment on how to make that process efficient.

We need to consider today a duel approach of both drugs and devices. That combination is going to require a KOL from a diverse background medically and structurally, such as the CEOs, the group purchasing organisations, the HMOs, because ultimately that’s how we’re going to most efficiently treat chronic diseases.

RA: Thank you very much for your time Professor Fitzgerald and for you insights.

PF: Thank you.

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About the interviewee:

Dr. Peter Fitzgerald is the Director of the Center for Cardiovascular Technology and Director of the Cardiovascular Core Analysis Laboratory (CCAL) at Stanford University Medical School. He is an Interventional Cardiologist and has a PhD in Engineering. He is Professor in both the Departments of Medicine and Engineering at Stanford. Presently, Dr. Fitzgerald’s laboratory includes 14 postdoctoral fellows and graduate engineering students focusing on state-of-the-art technologies in Cardiovascular Medicine. He has led or participated in over 150 clinical trials, published over 450 manuscripts/chapters, and lectures worldwide. He has trained over 150 post-docs in Engineering and Medicine in the past decade.

Peter has been principle/founder of fifteen medical device companies in the San Francisco Bay Area. He has transitioned ten of these start-ups to large medical device companies. He serves on several boards of directors, advised dozens of medical device startups as well as multinational healthcare companies in the design and development of new diagnostic and therapeutic devices in the cardiovascular arena. In 2001, Peter was on the founding team of LVP Capital, a venture firm, focused on medical device and biotechnology start-ups in San Francisco. In 2008, he co-founded TriVentures, which is an incubator for early stage medical technology in Israel and heads the Stanford-Taiwan Med Tech innovation program.

What challenges do healthcare practitioners face as they embrace new technologies in medicine?